10D2012416 CLIA NUMBER - WALGREEN CO

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Laboratory Demographics

CLIA Number: 10D2012416

Facility Name: WALGREEN CO

Facility Address:
113 MAITLAND AVE
ALTAMONTE SPRINGS, FL
ZIP 32701
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Facility Phone Number: 407 331-4698

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1104831395

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	10D2012416
LAB Type	Pharmacy
Facility Name	WALGREEN CO
Street	113 MAITLAND AVE
City	ALTAMONTE SPRINGS
State	FL
ZIP	32701
Phone	407 331-4698
CertificateType	4
CertificateEffectiveDate	5/11/2023
CertificateExpirationDate	5/10/2025
FacilityType	Waiver

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