29D2218476 CLIA NUMBER - WALGREENS #04788

Laboratory Demographics

  • CLIA Code: 29D2218476
  • Facility Name: WALGREENS #04788
  • Facility Address: 1465 E WILLIAM ST
    CARSON CITY, NV
    ZIP 89701
  • Facility Phone: 775 841-2790
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TANYA M. DEMICHELE
  • NPI Number: 1710992789
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 29D2218476
LAB Type Pharmacy
Facility Name WALGREENS #04788
Street 1465 E WILLIAM ST
City CARSON CITY
State NV
ZIP 89701
Phone 775 841-2790
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/29/2025
Certificate Expiration Date 3/28/2027
Facility Type Pharmacy
Lab Director TANYA M. DEMICHELE

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