10D2012350 CLIA NUMBER - WALGREEN CO

Laboratory Demographics

  • CLIA Code: 10D2012350
  • Facility Name: WALGREEN CO
  • Facility Address: 3090 W NEW HAVEN AVE
    WEST MELBOURNE, FL
    ZIP 32904
  • Facility Phone: 321 727-8453
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHRISITA S. ACKERMANN
  • NPI Number: 1669487971
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 10D2012350
LAB Type Pharmacy
Facility Name WALGREEN CO
Street 3090 W NEW HAVEN AVE
City WEST MELBOURNE
State FL
ZIP 32904
Phone 321 727-8453
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/10/2025
Certificate Expiration Date 5/9/2027
Facility Type Pharmacy
Lab Director CHRISITA S. ACKERMANN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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