20D2288995 CLIA NUMBER - WALGREENS 11886

Laboratory Demographics

  • CLIA Code: 20D2288995
  • Facility Name: WALGREENS 11886
  • Facility Address: 127 MARGINAL WAY
    PORTLAND, ME
    ZIP 04101
  • Facility Phone: 207 771-5631
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAKE R. ALOFS
  • NPI Number: 1740585553
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 20D2288995
LAB Type Pharmacy
Facility Name WALGREENS 11886
Street 127 MARGINAL WAY
City PORTLAND
State ME
ZIP 04101
Phone 207 771-5631
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/5/2023
Certificate Expiration Date 9/4/2025
Facility Type Pharmacy
Lab Director JAKE R. ALOFS

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This page was last updated on: 6/4/2025