19D2038569 CLIA NUMBER - WALGREENS #05163

Laboratory Demographics

  • CLIA Code: 19D2038569
  • Facility Name: WALGREENS #05163
  • Facility Address: 300 SOUTHFIELD ROAD
    SHREVEPORT, LA
    ZIP 71105
  • Facility Phone: 318 219-9554
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DOMINIQUE M. MANO
  • NPI Number: 1043225212
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2038569
LAB Type Pharmacy
Facility Name WALGREENS #05163
Street 300 SOUTHFIELD ROAD
City SHREVEPORT
State LA
ZIP 71105
Phone 318 219-9554
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/28/2025
Certificate Expiration Date 4/27/2027
Facility Type Pharmacy
Lab Director DOMINIQUE M. MANO

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