03D2064110 CLIA NUMBER - WALGREENS 01969

Laboratory Demographics

  • CLIA Code: 03D2064110
  • Facility Name: WALGREENS 01969
  • Facility Address: 6006 N 67TH AVE
    GLENDALE, AZ
    ZIP 85301
  • Facility Phone: 623 939-7571
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHAEL NIMAKO-GYASSI
  • NPI Number: 1366457699
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2064110
LAB Type Pharmacy
Facility Name WALGREENS 01969
Street 6006 N 67TH AVE
City GLENDALE
State AZ
ZIP 85301
Phone 623 939-7571
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/27/2025
Certificate Expiration Date 9/26/2027
Facility Type Pharmacy
Lab Director MICHAEL NIMAKO-GYASSI

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