10D2212290 CLIA NUMBER - WALGREENS # 11165

Laboratory Demographics

  • CLIA Code: 10D2212290
  • Facility Name: WALGREENS # 11165
  • Facility Address: 5445 STATE ROAD 16
    SAINT AUGUSTINE, FL
    ZIP 32092
  • Facility Phone: 904 940-5556
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: FERAS ALSHHADEH
  • NPI Number: 1205084266
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2212290
LAB Type Pharmacy
Facility Name WALGREENS # 11165
Street 5445 STATE ROAD 16
City SAINT AUGUSTINE
State FL
ZIP 32092
Phone 904 940-5556
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 Pharmacy
Lab Director FERAS ALSHHADEH

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