19D2220321 CLIA NUMBER - WALGREENS #15402

Laboratory Demographics

  • CLIA Code: 19D2220321
  • Facility Name: WALGREENS #15402
  • Facility Address: 625 HOMER RD
    MINDEN, LA
    ZIP 71055
  • Facility Phone: 318 371-5149
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TYLER VINCENT
  • NPI Number: 1720415128
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2220321
LAB Type Pharmacy
Facility Name WALGREENS #15402
Street 625 HOMER RD
City MINDEN
State LA
ZIP 71055
Phone 318 371-5149
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 TYLER VINCENT

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