03D2030113 CLIA NUMBER - WALGREENS #09652

Laboratory Demographics

  • CLIA Code: 03D2030113
  • Facility Name: WALGREENS #09652
  • Facility Address: 1575 N ARIZONA BLVD
    COOLIDGE, AZ
    ZIP 85128
  • Facility Phone: 520 723-5480
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LISA M. GOMEZ
  • NPI Number: 1124074448
  • Taxonomy: 333600000X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/19/2025
Certificate Expiration Date 3/18/2027
Facility Type Pharmacy
Lab Director LISA M. GOMEZ

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