03D2011632 CLIA NUMBER - WALGREENS #05208

Laboratory Demographics

  • CLIA Code: 03D2011632
  • Facility Name: WALGREENS #05208
  • Facility Address: 25 LAKE HAVASU AVE S
    LAKE HAVASU, AZ
    ZIP 86403
  • Facility Phone: 928 453-2808
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PRERANA SEVAK
  • NPI Number: 1437164761
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2011632
LAB Type Pharmacy
Facility Name WALGREENS #05208
Street 25 LAKE HAVASU AVE S
City LAKE HAVASU
State AZ
ZIP 86403
Phone 928 453-2808
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 PRERANA SEVAK

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