03D2013011 CLIA NUMBER - WALGREENS #04620

Laboratory Demographics

  • CLIA Code: 03D2013011
  • Facility Name: WALGREENS #04620
  • Facility Address: 15490 W BELL RD
    SURPRISE, AZ
    ZIP 85374
  • Facility Phone: 623 546-0032
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARK W. SCHELLENHAUM
  • NPI Number: 1396750642
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2013011
LAB Type Pharmacy
Facility Name WALGREENS #04620
Street 15490 W BELL RD
City SURPRISE
State AZ
ZIP 85374
Phone 623 546-0032
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/11/2025
Certificate Expiration Date 5/10/2027
Facility Type Pharmacy
Lab Director MARK W. SCHELLENHAUM

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