10D2292496 CLIA NUMBER - WALGREEN CO

Laboratory Demographics

  • CLIA Code: 10D2292496
  • Facility Name: WALGREEN CO
  • Facility Address: 11190 SW 88TH ST
    MIAMI, FL
    ZIP 33176
  • Facility Phone: 305 275-9428
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KOTHA PRAKASH-BAHANU
  • NPI Number: 1215942404
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2292496
LAB Type Pharmacy
Facility Name WALGREEN CO
Street 11190 SW 88TH ST
City MIAMI
State FL
ZIP 33176
Phone 305 275-9428
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/26/2023
Certificate Expiration Date 10/25/2025
Facility Type Pharmacy
Lab Director KOTHA PRAKASH-BAHANU

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