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28D2158658 CLIA NUMBER - KEYSTONE RX CORPORATION INC DBA DAVE'S PHARMACY

Laboratory Demographics

CLIA Number: 28D2158658

Facility Name: KEYSTONE RX CORPORATION INC DBA DAVE'S PHARMACY

Facility Address:
223 BOX BUTTE AVENUE
ALLIANCE, NE
ZIP 69301
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Facility Phone Number: 308 762-4811

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1093206062

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name Field Value
CLIA Number 28D2158658
LAB Type Pharmacy
Facility Name KEYSTONE RX CORPORATION INC DBA DAVE'S PHARMACY
Street 223 BOX BUTTE AVENUE
City ALLIANCE
State NE
ZIP 69301
Phone 308 762-4811
CertificateType 4
CertificateEffectiveDate 12/4/2022
CertificateExpirationDate 12/3/2024
FacilityType Waiver

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