10D2012589 CLIA NUMBER - WALGREEN CO#MACY 07125

Laboratory Demographics

  • CLIA Code: 10D2012589
  • Facility Name: WALGREEN CO#MACY 07125
  • Facility Address: 1680 SE 17TH ST
    FORT LAUDERDALE, FL
    ZIP 33316
  • Facility Phone: 954 467-5448
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRIAN W. THAW
  • NPI Number: 1235146226
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2012589
LAB Type Pharmacy
Facility Name WALGREEN CO#MACY 07125
Street 1680 SE 17TH ST
City FORT LAUDERDALE
State FL
ZIP 33316
Phone 954 467-5448
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/16/2025
Certificate Expiration Date 10/15/2027
Facility Type Pharmacy
Lab Director BRIAN W. THAW

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