18D2029820 CLIA NUMBER - WALGREENS #12775

Laboratory Demographics

  • CLIA Code: 18D2029820
  • Facility Name: WALGREENS #12775
  • Facility Address: 550 W DIXIE AVE
    ELIZABETHTOWN, KY
    ZIP 42701
  • Facility Phone: 270 982-3088
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MS. STACY SIMS
  • NPI Number: 1194028167
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D2029820
LAB Type Pharmacy
Facility Name WALGREENS #12775
Street 550 W DIXIE AVE
City ELIZABETHTOWN
State KY
ZIP 42701
Phone 270 982-3088
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/25/2025
Certificate Expiration Date 3/24/2027
Facility Type Pharmacy
Lab Director MS. STACY SIMS

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