28D2220660 CLIA NUMBER - NEBRASKA CVS PHARMACY, LLC DBA CVS/PHARMACY #17392

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Laboratory Demographics

CLIA Number: 28D2220660

Facility Name: NEBRASKA CVS PHARMACY, LLC DBA CVS/PHARMACY #17392

Facility Address:
16959 EVANS PLAZA
OMAHA, NE
ZIP 68116
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Facility Phone Number: 402 970-1001

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1225222110

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	28D2220660
LAB Type	Pharmacy
Facility Name	NEBRASKA CVS PHARMACY, LLC DBA CVS/PHARMACY #17392
Street	16959 EVANS PLAZA
City	OMAHA
State	NE
ZIP	68116
Phone	402 970-1001
CertificateType	4
CertificateEffectiveDate	4/14/2023
CertificateExpirationDate	4/13/2025
FacilityType	Waiver

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