19D2038526 CLIA NUMBER - WALGREENS #2004

Laboratory Demographics

  • CLIA Code: 19D2038526
  • Facility Name: WALGREENS #2004
  • Facility Address: 1850 WEST PINHOOK ROAD
    LAFAYETTE, LA
    ZIP 70508
  • Facility Phone: 337 267-4614
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HEIDI E. VAN BROCKLIN
  • NPI Number: 1326054826
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2038526
LAB Type Pharmacy
Facility Name WALGREENS #2004
Street 1850 WEST PINHOOK ROAD
City LAFAYETTE
State LA
ZIP 70508
Phone 337 267-4614
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/13/2025
Certificate Expiration Date 8/12/2027
Facility Type Pharmacy
Lab Director HEIDI E. VAN BROCKLIN

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