03D2070858 CLIA NUMBER - WALGREENS #04228

Laboratory Demographics

  • CLIA Code: 03D2070858
  • Facility Name: WALGREENS #04228
  • Facility Address: 5125 W NORTHERN AVE
    GLENDALE, AZ
    ZIP 85301
  • Facility Phone: 623 842-1289
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MAMTA PARESH PATEL
  • NPI Number: 1306852009
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2070858
LAB Type Pharmacy
Facility Name WALGREENS #04228
Street 5125 W NORTHERN AVE
City GLENDALE
State AZ
ZIP 85301
Phone 623 842-1289
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/12/2025
Certificate Expiration Date 5/11/2027
Facility Type Pharmacy
Lab Director MAMTA PARESH PATEL

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