03D2011638 CLIA NUMBER - WALGREENS #05027

Laboratory Demographics

  • CLIA Code: 03D2011638
  • Facility Name: WALGREENS #05027
  • Facility Address: 1950 E FRY BLVD
    SIERRA VISTA, AZ
    ZIP 85635
  • Facility Phone: 520 458-5638
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CLAYTON LARSON
  • NPI Number: 1760497010
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2011638
LAB Type Pharmacy
Facility Name WALGREENS #05027
Street 1950 E FRY BLVD
City SIERRA VISTA
State AZ
ZIP 85635
Phone 520 458-5638
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 CLAYTON LARSON

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