03D2063054 CLIA NUMBER - WALGREENS #05701

Laboratory Demographics

  • CLIA Code: 03D2063054
  • Facility Name: WALGREENS #05701
  • Facility Address: 1158 S CRISMON RD
    MESA, AZ
    ZIP 85208
  • Facility Phone: 480 358-9642
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: OLEG BERSHAD
  • NPI Number: 1467468850
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2063054
LAB Type Pharmacy
Facility Name WALGREENS #05701
Street 1158 S CRISMON RD
City MESA
State AZ
ZIP 85208
Phone 480 358-9642
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/18/2025
Certificate Expiration Date 10/17/2027
Facility Type Pharmacy
Lab Director OLEG BERSHAD

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