03D2064148 CLIA NUMBER - WALGREENS #04791

Laboratory Demographics

  • CLIA Code: 03D2064148
  • Facility Name: WALGREENS #04791
  • Facility Address: 14285 W GRAND AVE
    SURPRISE, AZ
    ZIP 85374
  • Facility Phone: 623 975-3944
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KIMBERLY J. KOSTIW
  • NPI Number: 1467468876
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2064148
LAB Type Pharmacy
Facility Name WALGREENS #04791
Street 14285 W GRAND AVE
City SURPRISE
State AZ
ZIP 85374
Phone 623 975-3944
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 KIMBERLY J. KOSTIW

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