18D2011092 CLIA NUMBER - WALGREENS #05813

Laboratory Demographics

  • CLIA Code: 18D2011092
  • Facility Name: WALGREENS #05813
  • Facility Address: 11930 STANDIFORD PLAZA DR
    LOUISVILLE, KY
    ZIP 40229
  • Facility Phone: 502 961-5843
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MS. DEBRA TETRICK
  • NPI Number: 1134134380
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D2011092
LAB Type Pharmacy
Facility Name WALGREENS #05813
Street 11930 STANDIFORD PLAZA DR
City LOUISVILLE
State KY
ZIP 40229
Phone 502 961-5843
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/26/2023
Certificate Expiration Date 4/25/2025
Facility Type Pharmacy
Lab Director MS. DEBRA TETRICK

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This page was last updated on: 3/20/2025