03D2064169 CLIA NUMBER - WALGREENS #05392

Laboratory Demographics

  • CLIA Code: 03D2064169
  • Facility Name: WALGREENS #05392
  • Facility Address: 420 S SOSSAMAN RD
    MESA, AZ
    ZIP 85208
  • Facility Phone: 480 325-4777
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TIA C. CLARK
  • NPI Number: 1275548521
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2064169
LAB Type Pharmacy
Facility Name WALGREENS #05392
Street 420 S SOSSAMAN RD
City MESA
State AZ
ZIP 85208
Phone 480 325-4777
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/12/2025
Certificate Expiration Date 7/11/2027
Facility Type Pharmacy
Lab Director TIA C. CLARK

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