28D2221999 CLIA NUMBER - WALGREENS #11204

Laboratory Demographics

  • CLIA Code: 28D2221999
  • Facility Name: WALGREENS #11204
  • Facility Address: 20201 MANDERSON ST
    OMAHA, NE
    ZIP 68022
  • Facility Phone: 402 289-0520
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BAILEY LEE
  • NPI Number: 1568654135
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 28D2221999
LAB Type Pharmacy
Facility Name WALGREENS #11204
Street 20201 MANDERSON ST
City OMAHA
State NE
ZIP 68022
Phone 402 289-0520
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/26/2025
Certificate Expiration Date 4/25/2027
Facility Type Pharmacy
Lab Director BAILEY LEE

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