10D2012358 CLIA NUMBER - WALGREEN CO

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Laboratory Demographics

CLIA Number: 10D2012358

Facility Name: WALGREEN CO

Facility Address:
1111 W VINE STREET
KISSIMMEE, FL
ZIP 34741
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Facility Phone Number: 407 847-5252

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1215944293

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	10D2012358
LAB Type	Pharmacy
Facility Name	WALGREEN CO
Street	1111 W VINE STREET
City	KISSIMMEE
State	FL
ZIP	34741
Phone	407 847-5252
CertificateType	4
CertificateEffectiveDate	6/7/2023
CertificateExpirationDate	6/6/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024