10D2225579 CLIA NUMBER - WALGREEN CO

Laboratory Demographics

  • CLIA Code: 10D2225579
  • Facility Name: WALGREEN CO
  • Facility Address: 4451 W 12TH AVE
    HIALEAH, FL
    ZIP 33012
  • Facility Phone: 305 556-8676
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SRILATHA PATLOLLA
  • NPI Number: 1811902042
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2225579
LAB Type Pharmacy
Facility Name WALGREEN CO
Street 4451 W 12TH AVE
City HIALEAH
State FL
ZIP 33012
Phone 305 556-8676
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/21/2025
Certificate Expiration Date 5/20/2027
Facility Type Pharmacy
Lab Director SRILATHA PATLOLLA

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