28D2023645 CLIA NUMBER - WALGREENS #12405

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Laboratory Demographics

CLIA Number: 28D2023645

Facility Name: WALGREENS #12405

Facility Address:
102 E PHILIP AVENUE
NORTH PLATTE, NE
ZIP 69101
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Facility Phone Number: 308 532-4303

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1588994172

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	28D2023645
LAB Type	Pharmacy
Facility Name	WALGREENS #12405
Street	102 E PHILIP AVENUE
City	NORTH PLATTE
State	NE
ZIP	69101
Phone	308 532-4303
CertificateType	4
CertificateEffectiveDate	5/21/2023
CertificateExpirationDate	5/20/2025
FacilityType	Waiver

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