19D2223186 CLIA NUMBER - WALGREENS #12626

Laboratory Demographics

  • CLIA Code: 19D2223186
  • Facility Name: WALGREENS #12626
  • Facility Address: 1000 S ACADIA RD
    THIBODAUX, LA
    ZIP 70301
  • Facility Phone: 985 449-2626
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GLEN M. GRAMBRONE
  • NPI Number: 1144450552
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2223186
LAB Type Pharmacy
Facility Name WALGREENS #12626
Street 1000 S ACADIA RD
City THIBODAUX
State LA
ZIP 70301
Phone 985 449-2626
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/4/2025
Certificate Expiration Date 5/3/2027
Facility Type Pharmacy
Lab Director GLEN M. GRAMBRONE

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