10D2226456 CLIA NUMBER - WALGREEN CO

Laboratory Demographics

CLIA Number: 10D2226456

Facility Name: WALGREEN CO

Facility Address:
1829 RIDGEWOOD AVE
HOLLY HILL, FL
ZIP 32117
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Facility Phone Number: 386 672-6388

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1922013119

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	10D2226456
LAB Type	Pharmacy
Facility Name	WALGREEN CO
Street	1829 RIDGEWOOD AVE
City	HOLLY HILL
State	FL
ZIP	32117
Phone	386 672-6388
CertificateType	4
CertificateEffectiveDate	6/1/2023
CertificateExpirationDate	5/31/2025
FacilityType	Waiver

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