10D2012450 CLIA NUMBER - WALGREEN CO

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Laboratory Demographics

CLIA Number: 10D2012450

Facility Name: WALGREEN CO

Facility Address:
15601 SAN CARLOS BLVD
FORT MYERS, FL
ZIP 33908
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Facility Phone Number: 239 489-2223

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1093721482

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	10D2012450
LAB Type	Pharmacy
Facility Name	WALGREEN CO
Street	15601 SAN CARLOS BLVD
City	FORT MYERS
State	FL
ZIP	33908
Phone	239 489-2223
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