19D2015539 CLIA NUMBER - WALGREENS # 07004

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Laboratory Demographics

CLIA Number: 19D2015539

Facility Name: WALGREENS # 07004

Facility Address:
2107 AIRLINE DR
BOSSIER CITY, LA
ZIP 71111
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Facility Phone Number: 318 742-5590

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1760497937

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	19D2015539
LAB Type	Pharmacy
Facility Name	WALGREENS # 07004
Street	2107 AIRLINE DR
City	BOSSIER CITY
State	LA
ZIP	71111
Phone	318 742-5590
CertificateType	4
CertificateEffectiveDate	4/16/2023
CertificateExpirationDate	4/15/2025
FacilityType	Waiver

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