03D2064172 CLIA NUMBER - WALGREENS #12334

Laboratory Demographics

  • CLIA Code: 03D2064172
  • Facility Name: WALGREENS #12334
  • Facility Address: 1654 N PEBBLE CREEK PKWY
    GOODYEAR, AZ
    ZIP 85395
  • Facility Phone: 623 207-6808
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STANISLAV SAZONOV
  • NPI Number: 1215265145
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2064172
LAB Type Pharmacy
Facility Name WALGREENS #12334
Street 1654 N PEBBLE CREEK PKWY
City GOODYEAR
State AZ
ZIP 85395
Phone 623 207-6808
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/11/2025
Certificate Expiration Date 3/10/2027
Facility Type Pharmacy
Lab Director STANISLAV SAZONOV

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