20D2198783 CLIA NUMBER - WALGREENS #17159

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Laboratory Demographics

CLIA Number: 20D2198783

Facility Name: WALGREENS #17159

Facility Address:
7 PORTLAND STREET
RUMFORD, ME
ZIP 04276
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Facility Phone Number: 207 364-2969

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1457875189

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	20D2198783
LAB Type	Pharmacy
Facility Name	WALGREENS #17159
Street	7 PORTLAND STREET
City	RUMFORD
State	ME
ZIP	04276
Phone	207 364-2969
CertificateType	4
CertificateEffectiveDate	11/4/2022
CertificateExpirationDate	11/3/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024