06D2012941 CLIA NUMBER - WALGREENS #04721

Laboratory Demographics

  • CLIA Code: 06D2012941
  • Facility Name: WALGREENS #04721
  • Facility Address: 2900 W NORTHERN AVE
    PUEBLO, CO
    ZIP 81005
  • Facility Phone: 719 561-9728
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DANIEL S. ILER
  • NPI Number: 1699780932
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 06D2012941
LAB Type Pharmacy
Facility Name WALGREENS #04721
Street 2900 W NORTHERN AVE
City PUEBLO
State CO
ZIP 81005
Phone 719 561-9728
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/5/2025
Certificate Expiration Date 4/4/2027
Facility Type Pharmacy
Lab Director DANIEL S. ILER

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