03D2011595 CLIA NUMBER - WALGREENS #05776

Laboratory Demographics

  • CLIA Code: 03D2011595
  • Facility Name: WALGREENS #05776
  • Facility Address: 1451 N DYSART RD
    AVONDALE, AZ
    ZIP 85323
  • Facility Phone: 623 925-0280
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DELORES M. WALTON
  • NPI Number: 1679588909
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2011595
LAB Type Pharmacy
Facility Name WALGREENS #05776
Street 1451 N DYSART RD
City AVONDALE
State AZ
ZIP 85323
Phone 623 925-0280
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/9/2025
Certificate Expiration Date 4/8/2027
Facility Type Pharmacy
Lab Director DELORES M. WALTON

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