10D2012588 CLIA NUMBER - WALGREEN CO

Laboratory Demographics

  • CLIA Code: 10D2012588
  • Facility Name: WALGREEN CO
  • Facility Address: 340 SW 24TH ST
    FORT LAUDERDALE, FL
    ZIP 33315
  • Facility Phone: 954 764-1584
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: THOMAS GRANDSTAFF
  • NPI Number: 1417962762
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2012588
LAB Type Pharmacy
Facility Name WALGREEN CO
Street 340 SW 24TH ST
City FORT LAUDERDALE
State FL
ZIP 33315
Phone 954 764-1584
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/18/2025
Certificate Expiration Date 5/17/2027
Facility Type Pharmacy
Lab Director THOMAS GRANDSTAFF

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