10D2012436 CLIA NUMBER - WALGREEN CO

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Laboratory Demographics

CLIA Number: 10D2012436

Facility Name: WALGREEN CO

Facility Address:
12749 S CLEVELAND AVE
FORT MYERS, FL
ZIP 33907
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Facility Phone Number: 239 939-2142

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1750392999

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	10D2012436
LAB Type	Pharmacy
Facility Name	WALGREEN CO
Street	12749 S CLEVELAND AVE
City	FORT MYERS
State	FL
ZIP	33907
Phone	239 939-2142
CertificateType	4
CertificateEffectiveDate	5/26/2023
CertificateExpirationDate	5/25/2025
FacilityType	Waiver

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