10D2212284 CLIA NUMBER - WALGREENS #10972

Laboratory Demographics

  • CLIA Code: 10D2212284
  • Facility Name: WALGREENS #10972
  • Facility Address: 8309 SOUTHSIDE BLVD
    JACKSONVILLE, FL
    ZIP 32256
  • Facility Phone: 904 672-1999
  • Facility Type: Other - COVID TESTING
  • Facility Type: Waiver
  • Lab Director: BENJAMIN J. VILLAVICENCIO-LAZO
  • NPI Number: 1154552321
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2212284
LAB Type Other - COVID TESTING
Facility Name WALGREENS #10972
Street 8309 SOUTHSIDE BLVD
City JACKSONVILLE
State FL
ZIP 32256
Phone 904 672-1999
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/3/2025
Certificate Expiration Date 2/2/2027
Facility Type Other - COVID TESTING
Lab Director BENJAMIN J. VILLAVICENCIO-LAZO

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