19D2037515 CLIA NUMBER - WALGREENS #09690

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Laboratory Demographics

CLIA Number: 19D2037515

Facility Name: WALGREENS #09690

Facility Address:
1100 W PINE STREET
PONCHATOULA, LA
ZIP 70454
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Facility Phone Number: 985 386-2421

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1083701213

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	19D2037515
LAB Type	Pharmacy
Facility Name	WALGREENS #09690
Street	1100 W PINE STREET
City	PONCHATOULA
State	LA
ZIP	70454
Phone	985 386-2421
CertificateType	4
CertificateEffectiveDate	12/15/2022
CertificateExpirationDate	12/14/2024
FacilityType	Waiver

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