28D2052112 CLIA NUMBER - WALGREENS #12854

Laboratory Demographics

  • CLIA Code: 28D2052112
  • Facility Name: WALGREENS #12854
  • Facility Address: 502 SOUTH 11TH STREET
    NEBRASKA CITY, NE
    ZIP 68410
  • Facility Phone: 402 873-1012
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TIM L. MUNTZ
  • NPI Number: 1578891818
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 28D2052112
LAB Type Pharmacy
Facility Name WALGREENS #12854
Street 502 SOUTH 11TH STREET
City NEBRASKA CITY
State NE
ZIP 68410
Phone 402 873-1012
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/21/2025
Certificate Expiration Date 5/20/2027
Facility Type Pharmacy
Lab Director TIM L. MUNTZ

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