05D2308161 CLIA NUMBER - WALGREENS 11611

Laboratory Demographics

  • CLIA Code: 05D2308161
  • Facility Name: WALGREENS 11611
  • Facility Address: 50040 CESAR CHAVEZ ST
    COACHELLA, CA
    ZIP 92236
  • Facility Phone: 760 391-5395
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DAVIS R. MOURCUS
  • NPI Number: 1346558921
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2308161
LAB Type Pharmacy
Facility Name WALGREENS 11611
Street 50040 CESAR CHAVEZ ST
City COACHELLA
State CA
ZIP 92236
Phone 760 391-5395
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/23/2024
Certificate Expiration Date 7/22/2026
Facility Type Pharmacy
Lab Director DAVIS R. MOURCUS

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