10D2226509 CLIA NUMBER - WALGREEN CO

Laboratory Demographics

  • CLIA Code: 10D2226509
  • Facility Name: WALGREEN CO
  • Facility Address: 13905 OLD ST AUGUSTINE RD
    JACKSONVILLE, FL
    ZIP 32258
  • Facility Phone: 904 268-9025
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: VENKATA R. AMMANABROLU
  • NPI Number: 1588679773
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2226509
LAB Type Pharmacy
Facility Name WALGREEN CO
Street 13905 OLD ST AUGUSTINE RD
City JACKSONVILLE
State FL
ZIP 32258
Phone 904 268-9025
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/1/2025
Certificate Expiration Date 5/31/2027
Facility Type Pharmacy
Lab Director VENKATA R. AMMANABROLU

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