03D2012465 CLIA NUMBER - WALGREENS #02219

Laboratory Demographics

  • CLIA Code: 03D2012465
  • Facility Name: WALGREENS #02219
  • Facility Address: 2801 S 4TH AVE
    YUMA, AZ
    ZIP 85364
  • Facility Phone: 928 344-0453
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KESEGOFETSE KETSHABILE-NKOBELA
  • NPI Number: 1760498166
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2012465
LAB Type Pharmacy
Facility Name WALGREENS #02219
Street 2801 S 4TH AVE
City YUMA
State AZ
ZIP 85364
Phone 928 344-0453
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/2/2025
Certificate Expiration Date 4/1/2027
Facility Type Pharmacy
Lab Director KESEGOFETSE KETSHABILE-NKOBELA

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