01D2221272 CLIA NUMBER - WALGREENS #11704

Laboratory Demographics

CLIA Number: 01D2221272

Facility Name: WALGREENS #11704

Facility Address:
5301 SUMMERVILLE ROAD
PHENIX CITY, AL
ZIP 36867
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Facility Phone Number: 334 297-3061

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1457508509

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	01D2221272
LAB Type	Pharmacy
Facility Name	WALGREENS #11704
Street	5301 SUMMERVILLE ROAD
City	PHENIX CITY
State	AL
ZIP	36867
Phone	334 297-3061
CertificateType	4
CertificateEffectiveDate	4/20/2023
CertificateExpirationDate	4/19/2025
FacilityType	Waiver

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