18D2041779 CLIA NUMBER - WALGREENS #6104

Laboratory Demographics

  • CLIA Code: 18D2041779
  • Facility Name: WALGREENS #6104
  • Facility Address: 2901 FORT CAMPBELL BLVD
    HOPKINSVILLE, KY
    ZIP 42240
  • Facility Phone: 270 886-0128
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MS. AIDA FALTAS
  • NPI Number: 1134134372
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D2041779
LAB Type Pharmacy
Facility Name WALGREENS #6104
Street 2901 FORT CAMPBELL BLVD
City HOPKINSVILLE
State KY
ZIP 42240
Phone 270 886-0128
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/27/2025
Certificate Expiration Date 3/26/2027
Facility Type Pharmacy
Lab Director MS. AIDA FALTAS

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