20D2288993 CLIA NUMBER - WALGREENS 19821

Laboratory Demographics

CLIA Number: 20D2288993

Facility Name: WALGREENS 19821

Facility Address:
713 CONGRESS ST
PORTLAND, ME
ZIP 04102
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Facility Phone Number: 207 774-8456

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1992229025

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 20D2288993
LAB Type Pharmacy
Facility Name WALGREENS 19821
Street 713 CONGRESS ST
City PORTLAND
State ME
ZIP 04102
Phone 207 774-8456
CertificateType 4
CertificateEffectiveDate 9/5/2023
CertificateExpirationDate 9/4/2025
FacilityType Waiver

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