07D2225189 CLIA NUMBER - WALGREENS #05407

Laboratory Demographics

  • CLIA Code: 07D2225189
  • Facility Name: WALGREENS #05407
  • Facility Address: 295 MAIN ST
    MANCHESTER, CT
    ZIP 06040
  • Facility Phone: 860 649-8747
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KYLE DUFAULT
  • NPI Number: 1639692072
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 07D2225189
LAB Type Pharmacy
Facility Name WALGREENS #05407
Street 295 MAIN ST
City MANCHESTER
State CT
ZIP 06040
Phone 860 649-8747
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/19/2025
Certificate Expiration Date 5/18/2027
Facility Type Pharmacy
Lab Director KYLE DUFAULT

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This page was last updated on: 6/4/2025