03D2012319 CLIA NUMBER - WALGREENS #05221

Laboratory Demographics

  • CLIA Code: 03D2012319
  • Facility Name: WALGREENS #05221
  • Facility Address: 1025 S MILTON RD
    FLAGSTAFF, AZ
    ZIP 86001
  • Facility Phone: 928 779-9588
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TRAVIS MARTINEZ
  • NPI Number: 1366457616
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2012319
LAB Type Pharmacy
Facility Name WALGREENS #05221
Street 1025 S MILTON RD
City FLAGSTAFF
State AZ
ZIP 86001
Phone 928 779-9588
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/11/2025
Certificate Expiration Date 3/10/2027
Facility Type Pharmacy
Lab Director TRAVIS MARTINEZ

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