28D2013335 CLIA NUMBER - WALGREENS #04754

Laboratory Demographics

  • CLIA Code: 28D2013335
  • Facility Name: WALGREENS #04754
  • Facility Address: 8380 HARRISON STREET
    LAVISTA, NE
    ZIP 68128
  • Facility Phone: 402 592-7990
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ERIC SUNDSBOE
  • NPI Number: 1346255387
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 28D2013335
LAB Type Pharmacy
Facility Name WALGREENS #04754
Street 8380 HARRISON STREET
City LAVISTA
State NE
ZIP 68128
Phone 402 592-7990
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/17/2025
Certificate Expiration Date 5/16/2027
Facility Type Pharmacy
Lab Director ERIC SUNDSBOE

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This page was last updated on: 9/29/2025