19D2220408 CLIA NUMBER - WALGREENS #04290

Laboratory Demographics

  • CLIA Code: 19D2220408
  • Facility Name: WALGREENS #04290
  • Facility Address: 100 N MILITARY RD
    SLIDELL, LA
    ZIP 70461
  • Facility Phone: 985 645-0488
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BENJAMIN GANDOLFI
  • NPI Number: 1023023280
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2220408
LAB Type Pharmacy
Facility Name WALGREENS #04290
Street 100 N MILITARY RD
City SLIDELL
State LA
ZIP 70461
Phone 985 645-0488
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 BENJAMIN GANDOLFI

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