28D2012918 CLIA NUMBER - WALGREENS 04753

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Laboratory Demographics

CLIA Number: 28D2012918

Facility Name: WALGREENS 04753

Facility Address:
1404 SUPERIOR STREET
LINCOLN, NE
ZIP 68521
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Facility Phone Number: 402 477-2622

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1538174586

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	28D2012918
LAB Type	Pharmacy
Facility Name	WALGREENS 04753
Street	1404 SUPERIOR STREET
City	LINCOLN
State	NE
ZIP	68521
Phone	402 477-2622
CertificateType	4
CertificateEffectiveDate	9/13/2023
CertificateExpirationDate	9/12/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024