20D2288991 CLIA NUMBER - WALGREENS 19464

Laboratory Demographics

  • CLIA Code: 20D2288991
  • Facility Name: WALGREENS 19464
  • Facility Address: 290 CONGRESS ST
    PORTLAND, ME
    ZIP 04101
  • Facility Phone: 207 774-0344
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HEINRICH F. WICHMANN
  • NPI Number: 1770007585
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 20D2288991
LAB Type Pharmacy
Facility Name WALGREENS 19464
Street 290 CONGRESS ST
City PORTLAND
State ME
ZIP 04101
Phone 207 774-0344
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/5/2025
Certificate Expiration Date 9/4/2027
Facility Type Pharmacy
Lab Director HEINRICH F. WICHMANN

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