19D2239260 CLIA NUMBER - WALGREENS #17049

Laboratory Demographics

  • CLIA Code: 19D2239260
  • Facility Name: WALGREENS #17049
  • Facility Address: 2090 GAUSE BLVD E
    SLIDELL, LA
    ZIP 70461
  • Facility Phone: 985 641-3847
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ARIYAN T. FRAZIER
  • NPI Number: 1043735517
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2239260
LAB Type Pharmacy
Facility Name WALGREENS #17049
Street 2090 GAUSE BLVD E
City SLIDELL
State LA
ZIP 70461
Phone 985 641-3847
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/11/2023
Certificate Expiration Date 10/10/2025
Facility Type Pharmacy
Lab Director ARIYAN T. FRAZIER

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