01D2221242 CLIA NUMBER - WALGREEN #06464

Laboratory Demographics

  • CLIA Code: 01D2221242
  • Facility Name: WALGREEN #06464
  • Facility Address: 3120 BOB WALLACE AVE SW
    HUNTSVILLE, AL
    ZIP 35805
  • Facility Phone: 256 533-5058
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JERRY WHITESIDE
  • NPI Number: 1083629349
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 01D2221242
LAB Type Pharmacy
Facility Name WALGREEN #06464
Street 3120 BOB WALLACE AVE SW
City HUNTSVILLE
State AL
ZIP 35805
Phone 256 533-5058
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2025
Certificate Expiration Date 4/19/2027
Facility Type Pharmacy
Lab Director JERRY WHITESIDE

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