20D2200378 CLIA NUMBER - WALGREENS #17355

Laboratory Demographics

  • CLIA Code: 20D2200378
  • Facility Name: WALGREENS #17355
  • Facility Address: 66 MOOSEHEAD TRAIL
    NEWPORT, ME
    ZIP 04953
  • Facility Phone: 207 368-5754
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SHANTAN R. REDDY
  • NPI Number: 1295259158
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 20D2200378
LAB Type Pharmacy
Facility Name WALGREENS #17355
Street 66 MOOSEHEAD TRAIL
City NEWPORT
State ME
ZIP 04953
Phone 207 368-5754
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 SHANTAN R. REDDY

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