19D2230112 CLIA NUMBER - WALGREENS #13779

Laboratory Demographics

  • CLIA Code: 19D2230112
  • Facility Name: WALGREENS #13779
  • Facility Address: 39527 HIGHWAY 42
    PRAIRIEVILLE, LA
    ZIP 70769
  • Facility Phone: 225 673-6374
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUDASAMA ANKOR
  • NPI Number: 1770863938
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2230112
LAB Type Pharmacy
Facility Name WALGREENS #13779
Street 39527 HIGHWAY 42
City PRAIRIEVILLE
State LA
ZIP 70769
Phone 225 673-6374
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/20/2025
Certificate Expiration Date 7/19/2027
Facility Type Pharmacy
Lab Director CHUDASAMA ANKOR

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