03D2062291 CLIA NUMBER - WALGREENS #05569

Laboratory Demographics

  • CLIA Code: 03D2062291
  • Facility Name: WALGREENS #05569
  • Facility Address: 1315 E CHANDLER BLVD
    PHOENIX, AZ
    ZIP 85048
  • Facility Phone: 480 460-3945
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KIRK G. JACKSON
  • NPI Number: 1740296110
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2062291
LAB Type Pharmacy
Facility Name WALGREENS #05569
Street 1315 E CHANDLER BLVD
City PHOENIX
State AZ
ZIP 85048
Phone 480 460-3945
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/9/2025
Certificate Expiration Date 7/8/2027
Facility Type Pharmacy
Lab Director KIRK G. JACKSON

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