19D2038567 CLIA NUMBER - WALGREENS #11997

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Laboratory Demographics

CLIA Number: 19D2038567

Facility Name: WALGREENS #11997

Facility Address:
5416 CAMERON ST
LAFAYETTE, LA
ZIP 70506
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Facility Phone Number: 337 266-5884

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1336310085

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	19D2038567
LAB Type	Pharmacy
Facility Name	WALGREENS #11997
Street	5416 CAMERON ST
City	LAFAYETTE
State	LA
ZIP	70506
Phone	337 266-5884
CertificateType	4
CertificateEffectiveDate	7/12/2023
CertificateExpirationDate	7/11/2025
FacilityType	Waiver

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