10D2013159 CLIA NUMBER - WALGREEN CO

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Laboratory Demographics

CLIA Number: 10D2013159

Facility Name: WALGREEN CO

Facility Address:
11115 E DR MARTIN LUTHER KING JR BLVD
SEFFNER, FL
ZIP 33584
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Facility Phone Number: 813 689-4049

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1699780700

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	10D2013159
LAB Type	Pharmacy
Facility Name	WALGREEN CO
Street	11115 E DR MARTIN LUTHER KING JR BLVD
City	SEFFNER
State	FL
ZIP	33584
Phone	813 689-4049
CertificateType	4
CertificateEffectiveDate	7/1/2023
CertificateExpirationDate	6/30/2025
FacilityType	Waiver

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