28D2013335 CLIA NUMBER - WALGREENS #04754

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Laboratory Demographics

CLIA Number: 28D2013335

Facility Name: WALGREENS #04754

Facility Address:
8380 HARRISON STREET
LAVISTA, NE
ZIP 68128
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Facility Phone Number: 402 592-7990

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1346255387

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	28D2013335
LAB Type	Pharmacy
Facility Name	WALGREENS #04754
Street	8380 HARRISON STREET
City	LAVISTA
State	NE
ZIP	68128
Phone	402 592-7990
CertificateType	4
CertificateEffectiveDate	5/17/2023
CertificateExpirationDate	5/16/2025
FacilityType	Waiver

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