19D2052917 CLIA NUMBER - WALGREENS #15109

Laboratory Demographics

  • CLIA Code: 19D2052917
  • Facility Name: WALGREENS #15109
  • Facility Address: 4327 JEFFERSON HWY
    JEFFERSON, LA
    ZIP 70121
  • Facility Phone: 504 731-1431
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TRACY R. WOLFE
  • NPI Number: 1548520844
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2052917
LAB Type Pharmacy
Facility Name WALGREENS #15109
Street 4327 JEFFERSON HWY
City JEFFERSON
State LA
ZIP 70121
Phone 504 731-1431
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/29/2025
Certificate Expiration Date 4/28/2027
Facility Type Pharmacy
Lab Director TRACY R. WOLFE

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