03D2011960 CLIA NUMBER - WALGREENS # 05504

Laboratory Demographics

  • CLIA Code: 03D2011960
  • Facility Name: WALGREENS # 05504
  • Facility Address: 4249 W GLEDALE AVE
    PHOENIX, AZ
    ZIP 85051
  • Facility Phone: 623 937-9231
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: FRED E. HANEY
  • NPI Number: 1679589048
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2011960
LAB Type Pharmacy
Facility Name WALGREENS # 05504
Street 4249 W GLEDALE AVE
City PHOENIX
State AZ
ZIP 85051
Phone 623 937-9231
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/19/2025
Certificate Expiration Date 10/18/2027
Facility Type Pharmacy
Lab Director FRED E. HANEY

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