19D2066167 CLIA NUMBER - WALGREENS #11413

Laboratory Demographics

  • CLIA Code: 19D2066167
  • Facility Name: WALGREENS #11413
  • Facility Address: 105 WEST HIGHWAY 30
    GONZALES, LA
    ZIP 70737
  • Facility Phone: 225 644-0434
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KAYLA H. MOSES
  • NPI Number: 1134318132
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2066167
LAB Type Pharmacy
Facility Name WALGREENS #11413
Street 105 WEST HIGHWAY 30
City GONZALES
State LA
ZIP 70737
Phone 225 644-0434
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/12/2025
Certificate Expiration Date 4/11/2027
Facility Type Pharmacy
Lab Director KAYLA H. MOSES

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