20D2200377 CLIA NUMBER - WALGREENS #12325

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Laboratory Demographics

CLIA Number: 20D2200377

Facility Name: WALGREENS #12325

Facility Address:
616 FOREST AVE
PORTLAND, ME
ZIP 04101
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Facility Phone Number: 207 761-9454

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1770816704

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	20D2200377
LAB Type	Pharmacy
Facility Name	WALGREENS #12325
Street	616 FOREST AVE
City	PORTLAND
State	ME
ZIP	04101
Phone	207 761-9454
CertificateType	4
CertificateEffectiveDate	11/16/2022
CertificateExpirationDate	11/15/2024
FacilityType	Waiver

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