03D2019558 CLIA NUMBER - WALGREENS # 04951

Laboratory Demographics

  • CLIA Code: 03D2019558
  • Facility Name: WALGREENS # 04951
  • Facility Address: 4006 E BELL RD
    PHOENIX, AZ
    ZIP 85032
  • Facility Phone: 602 971-1312
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOVENCIO DOMINGO
  • NPI Number: 1073529715
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2019558
LAB Type Pharmacy
Facility Name WALGREENS # 04951
Street 4006 E BELL RD
City PHOENIX
State AZ
ZIP 85032
Phone 602 971-1312
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/23/2025
Certificate Expiration Date 4/22/2027
Facility Type Pharmacy
Lab Director JOVENCIO DOMINGO

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