29D2242933 CLIA NUMBER - WALGREENS #04790

Laboratory Demographics

  • CLIA Code: 29D2242933
  • Facility Name: WALGREENS #04790
  • Facility Address: 5082 E LAKE MEAD BLVD
    LAS VEGAS, NV
    ZIP 89115
  • Facility Phone: 702 531-3028
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DANIEL TOBAR
  • NPI Number: 1447265418
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 29D2242933
LAB Type Pharmacy
Facility Name WALGREENS #04790
Street 5082 E LAKE MEAD BLVD
City LAS VEGAS
State NV
ZIP 89115
Phone 702 531-3028
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/15/2023
Certificate Expiration Date 11/14/2025
Facility Type Pharmacy
Lab Director DANIEL TOBAR

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