03D2022990 CLIA NUMBER - WALGREENS #12880

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Laboratory Demographics

CLIA Number: 03D2022990

Facility Name: WALGREENS #12880

Facility Address:
1925 E ANDY DEVINE AVE
KINGMAN, AZ
ZIP 86401
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Facility Phone Number: 928 753-7766

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1164750667

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	03D2022990
LAB Type	Pharmacy
Facility Name	WALGREENS #12880
Street	1925 E ANDY DEVINE AVE
City	KINGMAN
State	AZ
ZIP	86401
Phone	928 753-7766
CertificateType	4
CertificateEffectiveDate	4/5/2023
CertificateExpirationDate	4/4/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024