03D1095516 CLIA NUMBER - WALGREENS #12739

Laboratory Demographics

  • CLIA Code: 03D1095516
  • Facility Name: WALGREENS #12739
  • Facility Address: 15450 N TATUM BLVD
    PHOENIX, AZ
    ZIP 85032
  • Facility Phone: 602 996-3707
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STEPHANIE OHS
  • NPI Number: 1770598005
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 03D1095516
LAB Type Pharmacy
Facility Name WALGREENS #12739
Street 15450 N TATUM BLVD
City PHOENIX
State AZ
ZIP 85032
Phone 602 996-3707
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/19/2025
Certificate Expiration Date 3/18/2027
Facility Type Pharmacy
Lab Director STEPHANIE OHS

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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