03D2063108 CLIA NUMBER - WALGREENS #04422

Laboratory Demographics

  • CLIA Code: 03D2063108
  • Facility Name: WALGREENS #04422
  • Facility Address: 3945 E SOUTHERN AVE
    PHOENIX, AZ
    ZIP 85040
  • Facility Phone: 602 426-0501
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KAREN O. VICKERS
  • NPI Number: 1942215298
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2063108
LAB Type Pharmacy
Facility Name WALGREENS #04422
Street 3945 E SOUTHERN AVE
City PHOENIX
State AZ
ZIP 85040
Phone 602 426-0501
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/30/2025
Certificate Expiration Date 4/29/2027
Facility Type Pharmacy
Lab Director KAREN O. VICKERS

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