10D2011976 CLIA NUMBER - WALGREEN CO

Laboratory Demographics

  • CLIA Code: 10D2011976
  • Facility Name: WALGREEN CO
  • Facility Address: 1661 NW SAINT LUCIE WEST BLVD
    PORT SAINT LUCIE, FL
    ZIP 34986
  • Facility Phone: 772 873-1892
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JIM LOHSE
  • NPI Number: 1639184880
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2011976
LAB Type Pharmacy
Facility Name WALGREEN CO
Street 1661 NW SAINT LUCIE WEST BLVD
City PORT SAINT LUCIE
State FL
ZIP 34986
Phone 772 873-1892
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/24/2025
Certificate Expiration Date 5/23/2027
Facility Type Pharmacy
Lab Director JIM LOHSE

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