19D2037516 CLIA NUMBER - WALGREENS #11139

Laboratory Demographics

  • CLIA Code: 19D2037516
  • Facility Name: WALGREENS #11139
  • Facility Address: 108 WEST CALIFORNIA AVENUE
    RUSTON, LA
    ZIP 71270
  • Facility Phone: 318 255-1811
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: QUINTIN GOOD
  • NPI Number: 1114112505
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2037516
LAB Type Pharmacy
Facility Name WALGREENS #11139
Street 108 WEST CALIFORNIA AVENUE
City RUSTON
State LA
ZIP 71270
Phone 318 255-1811
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/12/2025
Certificate Expiration Date 4/11/2027
Facility Type Pharmacy
Lab Director QUINTIN GOOD

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