20D2198867 CLIA NUMBER - WALGREENS #11285

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Laboratory Demographics

CLIA Number: 20D2198867

Facility Name: WALGREENS #11285

Facility Address:
706 BROADWAY
BANGOR, ME
ZIP 04401
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Facility Phone Number: 207 262-0190

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1770758898

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	20D2198867
LAB Type	Pharmacy
Facility Name	WALGREENS #11285
Street	706 BROADWAY
City	BANGOR
State	ME
ZIP	04401
Phone	207 262-0190
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