10D2231925 CLIA NUMBER - WALGREEN CO

Laboratory Demographics

  • CLIA Code: 10D2231925
  • Facility Name: WALGREEN CO
  • Facility Address: 692 SW PRIMA VISTA BLVD
    PORT SAINT LUCIE, FL
    ZIP 34983
  • Facility Phone: 772 879-0522
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHARLENE M. DAUMKE
  • NPI Number: 1922013234
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2231925
LAB Type Pharmacy
Facility Name WALGREEN CO
Street 692 SW PRIMA VISTA BLVD
City PORT SAINT LUCIE
State FL
ZIP 34983
Phone 772 879-0522
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/9/2025
Certificate Expiration Date 8/8/2027
Facility Type Pharmacy
Lab Director CHARLENE M. DAUMKE

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