19D2042692 CLIA NUMBER - WALGREENS #05992

Laboratory Demographics

  • CLIA Code: 19D2042692
  • Facility Name: WALGREENS #05992
  • Facility Address: 3124 LINE AVENUE
    SHREVEPORT, LA
    ZIP 71104
  • Facility Phone: 318 222-4807
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HYON W. HIMES
  • NPI Number: 1497760664
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2042692
LAB Type Pharmacy
Facility Name WALGREENS #05992
Street 3124 LINE AVENUE
City SHREVEPORT
State LA
ZIP 71104
Phone 318 222-4807
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/19/2025
Certificate Expiration Date 7/18/2027
Facility Type Pharmacy
Lab Director HYON W. HIMES

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