10D2013124 CLIA NUMBER - WALGREENS #04569

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Laboratory Demographics

CLIA Number: 10D2013124

Facility Name: WALGREENS #04569

Facility Address:
3895 W BROWARD BLVD
PLANTATION, FL
ZIP 33312
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Facility Phone Number: 954 316-6641

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1457367914

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	10D2013124
LAB Type	Pharmacy
Facility Name	WALGREENS #04569
Street	3895 W BROWARD BLVD
City	PLANTATION
State	FL
ZIP	33312
Phone	954 316-6641
CertificateType	4
CertificateEffectiveDate	3/4/2023
CertificateExpirationDate	3/3/2025
FacilityType	Waiver

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