03D2030113 CLIA NUMBER - WALGREENS #09652

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Laboratory Demographics

CLIA Number: 03D2030113

Facility Name: WALGREENS #09652

Facility Address:
1575 N ARIZONA BLVD
COOLIDGE, AZ
ZIP 85128
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Facility Phone Number: 520 723-5480

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1124074448

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	03D2030113
LAB Type	Pharmacy
Facility Name	WALGREENS #09652
Street	1575 N ARIZONA BLVD
City	COOLIDGE
State	AZ
ZIP	85128
Phone	520 723-5480
CertificateType	4
CertificateEffectiveDate	3/19/2023
CertificateExpirationDate	3/18/2025
FacilityType	Waiver

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