19D2229735 CLIA NUMBER - WALGREENS #17092

Laboratory Demographics

  • CLIA Code: 19D2229735
  • Facility Name: WALGREENS #17092
  • Facility Address: 1214 GRAND CALLIOU ROAD
    HOUMA, LA
    ZIP 70363
  • Facility Phone: 985 873-3612
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SUZETTE B. JOHNSON
  • NPI Number: 1255850194
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2229735
LAB Type Pharmacy
Facility Name WALGREENS #17092
Street 1214 GRAND CALLIOU ROAD
City HOUMA
State LA
ZIP 70363
Phone 985 873-3612
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/15/2025
Certificate Expiration Date 7/14/2027
Facility Type Pharmacy
Lab Director SUZETTE B. JOHNSON

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