10D2013149 CLIA NUMBER - WALGREEN CO

Laboratory Demographics

  • CLIA Code: 10D2013149
  • Facility Name: WALGREEN CO
  • Facility Address: 930 PROVIDENCE RD
    BRANDON, FL
    ZIP 33511
  • Facility Phone: 813 684-7560
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMBRA R. MALSHI
  • NPI Number: 1811904808
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2013149
LAB Type Pharmacy
Facility Name WALGREEN CO
Street 930 PROVIDENCE RD
City BRANDON
State FL
ZIP 33511
Phone 813 684-7560
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/25/2025
Certificate Expiration Date 5/24/2027
Facility Type Pharmacy
Lab Director AMBRA R. MALSHI

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