10D2012365 CLIA NUMBER - WALGREEN CO

Laboratory Demographics

  • CLIA Code: 10D2012365
  • Facility Name: WALGREEN CO
  • Facility Address: 1350 N WICKHAM RD
    MELBOURNE, FL
    ZIP 32935
  • Facility Phone: 321 254-5507
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALICAI K. FORTENBERRY
  • NPI Number: 1457366684
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2012365
LAB Type Pharmacy
Facility Name WALGREEN CO
Street 1350 N WICKHAM RD
City MELBOURNE
State FL
ZIP 32935
Phone 321 254-5507
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/20/2025
Certificate Expiration Date 9/19/2027
Facility Type Pharmacy
Lab Director ALICAI K. FORTENBERRY

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