20D2200417 CLIA NUMBER - WALGREENS #19692

Laboratory Demographics

  • CLIA Code: 20D2200417
  • Facility Name: WALGREENS #19692
  • Facility Address: 120 MAIN ST
    GORHAM, ME
    ZIP 04038
  • Facility Phone: 207 839-3160
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHARLIE J. GREEN
  • NPI Number: 1982128088
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 20D2200417
LAB Type Pharmacy
Facility Name WALGREENS #19692
Street 120 MAIN ST
City GORHAM
State ME
ZIP 04038
Phone 207 839-3160
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 CHARLIE J. GREEN

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