03D2070859 CLIA NUMBER - WALGREENS #02209

Laboratory Demographics

  • CLIA Code: 03D2070859
  • Facility Name: WALGREENS #02209
  • Facility Address: 11420 S FORTUNA RD
    YUMA, AZ
    ZIP 85367
  • Facility Phone: 928 342-1034
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KESEGOFETSE KETSHABILE-NKOBETA
  • NPI Number: 1093949174
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2070859
LAB Type Pharmacy
Facility Name WALGREENS #02209
Street 11420 S FORTUNA RD
City YUMA
State AZ
ZIP 85367
Phone 928 342-1034
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/19/2025
Certificate Expiration Date 3/18/2027
Facility Type Pharmacy
Lab Director KESEGOFETSE KETSHABILE-NKOBETA

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