19D2015538 CLIA NUMBER - WALGREENS #02012

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Laboratory Demographics

CLIA Number: 19D2015538

Facility Name: WALGREENS #02012

Facility Address:
4444 JACKSON ST
ALEXANDRIA, LA
ZIP 71303
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Facility Phone Number: 318 448-9340

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1699780874

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	19D2015538
LAB Type	Pharmacy
Facility Name	WALGREENS #02012
Street	4444 JACKSON ST
City	ALEXANDRIA
State	LA
ZIP	71303
Phone	318 448-9340
CertificateType	4
CertificateEffectiveDate	4/12/2023
CertificateExpirationDate	4/11/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024