03D2066001 CLIA NUMBER - WALGREENS #09952

Laboratory Demographics

  • CLIA Code: 03D2066001
  • Facility Name: WALGREENS #09952
  • Facility Address: 12050 N DOVE MOUNTAIN BLVD
    MARANA, AZ
    ZIP 85658
  • Facility Phone: 520 225-0770
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAMES R. TOMLANOVICH
  • NPI Number: 1518105329
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2066001
LAB Type Pharmacy
Facility Name WALGREENS #09952
Street 12050 N DOVE MOUNTAIN BLVD
City MARANA
State AZ
ZIP 85658
Phone 520 225-0770
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/23/2025
Certificate Expiration Date 4/22/2027
Facility Type Pharmacy
Lab Director JAMES R. TOMLANOVICH

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