10D2227177 CLIA NUMBER - WALGREEN CO

Laboratory Demographics

CLIA Number: 10D2227177

Facility Name: WALGREEN CO

Facility Address:
2592 S JENKINS RD
FORT PIERCE, FL
ZIP 34947
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Facility Phone Number: 772 429-3174

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1093960148

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	10D2227177
LAB Type	Pharmacy
Facility Name	WALGREEN CO
Street	2592 S JENKINS RD
City	FORT PIERCE
State	FL
ZIP	34947
Phone	772 429-3174
CertificateType	4
CertificateEffectiveDate	6/9/2023
CertificateExpirationDate	6/8/2025
FacilityType	Waiver

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