28D2116839 CLIA NUMBER - KEYSTONE RX CORPORATION, INC D/B/A DAVE'S PHARMACY

Laboratory Demographics

  • CLIA Code: 28D2116839
  • Facility Name: KEYSTONE RX CORPORATION, INC D/B/A DAVE'S PHARMACY
  • Facility Address: 508 NIOBRARA AVENUE
    HEMINGFORD, NE
    ZIP 69348
  • Facility Phone: 308 487-5212
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. DAVID L. RANDOLPH
  • NPI Number: 1184231920
  • Taxonomy: 3336L0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 28D2116839
LAB Type Pharmacy
Facility Name KEYSTONE RX CORPORATION, INC D/B/A DAVE'S PHARMACY
Street 508 NIOBRARA AVENUE
City HEMINGFORD
State NE
ZIP 69348
Phone 308 487-5212
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/2/2024
Certificate Expiration Date 8/1/2026
Facility Type Pharmacy
Lab Director MR. DAVID L. RANDOLPH

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This page was last updated on: 6/4/2025