19D2037514 CLIA NUMBER - WALGREENS #09997

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Laboratory Demographics

CLIA Number: 19D2037514

Facility Name: WALGREENS #09997

Facility Address:
217 SUPERIOR AVENUE
BOGALUSA, LA
ZIP 70427
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Facility Phone Number: 985 735-6434

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1619168747

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	19D2037514
LAB Type	Pharmacy
Facility Name	WALGREENS #09997
Street	217 SUPERIOR AVENUE
City	BOGALUSA
State	LA
ZIP	70427
Phone	985 735-6434
CertificateType	4
CertificateEffectiveDate	6/8/2023
CertificateExpirationDate	6/7/2025
FacilityType	Waiver

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