03D2063103 CLIA NUMBER - WALGREENS #10111

Laboratory Demographics

  • CLIA Code: 03D2063103
  • Facility Name: WALGREENS #10111
  • Facility Address: 3434 W SOUTHERN AVE
    PHOENIX, AZ
    ZIP 85041
  • Facility Phone: 602 283-2071
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KNICKY S. HENDERSON
  • NPI Number: 1316138225
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2063103
LAB Type Pharmacy
Facility Name WALGREENS #10111
Street 3434 W SOUTHERN AVE
City PHOENIX
State AZ
ZIP 85041
Phone 602 283-2071
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/11/2025
Certificate Expiration Date 5/10/2027
Facility Type Pharmacy
Lab Director KNICKY S. HENDERSON

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