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

Laboratory Demographics

  • CLIA Code: 28D2158658
  • Facility Name: KEYSTONE RX CORPORATION INC DBA DAVE'S PHARMACY
  • Facility Address: 223 BOX BUTTE AVENUE
    ALLIANCE, NE
    ZIP 69301
  • Facility Phone: 308 762-4811
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. DAVID L. RANDOLPH
  • NPI Number: 1093206062
  • Taxonomy: 3336C0003X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/4/2024
Certificate Expiration Date 12/3/2026
Facility Type Pharmacy
Lab Director MR. DAVID L. RANDOLPH

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