20D2200377 CLIA NUMBER - WALGREENS #12325

Laboratory Demographics

  • CLIA Code: 20D2200377
  • Facility Name: WALGREENS #12325
  • Facility Address: 616 FOREST AVE
    PORTLAND, ME
    ZIP 04101
  • Facility Phone: 207 761-9454
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SANCHU THOMAS
  • NPI Number: 1770816704
  • Taxonomy: 333600000X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/16/2024
Certificate Expiration Date 11/15/2026
Facility Type Pharmacy
Lab Director SANCHU THOMAS

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