03D2063101 CLIA NUMBER - WALGREENS #04543

Laboratory Demographics

  • CLIA Code: 03D2063101
  • Facility Name: WALGREENS #04543
  • Facility Address: 805 S VAL VISTA DR
    GILBERT, AZ
    ZIP 85296
  • Facility Phone: 480 892-6039
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ISSOUF KONE
  • NPI Number: 1679588925
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2063101
LAB Type Pharmacy
Facility Name WALGREENS #04543
Street 805 S VAL VISTA DR
City GILBERT
State AZ
ZIP 85296
Phone 480 892-6039
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/12/2023
Certificate Expiration Date 5/11/2025
Facility Type Pharmacy
Lab Director ISSOUF KONE

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This page was last updated on: 3/20/2025