19D2037515 CLIA NUMBER - WALGREENS #09690

Laboratory Demographics

  • CLIA Code: 19D2037515
  • Facility Name: WALGREENS #09690
  • Facility Address: 1100 W PINE STREET
    PONCHATOULA, LA
    ZIP 70454
  • Facility Phone: 985 386-2421
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHELE STPIERRE
  • NPI Number: 1083701213
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2037515
LAB Type Pharmacy
Facility Name WALGREENS #09690
Street 1100 W PINE STREET
City PONCHATOULA
State LA
ZIP 70454
Phone 985 386-2421
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/15/2024
Certificate Expiration Date 12/14/2026
Facility Type Pharmacy
Lab Director MICHELE STPIERRE

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