20D2291447 CLIA NUMBER - WALGREENS 17364

Laboratory Demographics

  • CLIA Code: 20D2291447
  • Facility Name: WALGREENS 17364
  • Facility Address: 19 PORTLAND RD
    BRIDGTON, ME
    ZIP 04009
  • Facility Phone: 207 647-3445
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: FLORENCE F. JELLO
  • NPI Number: 1215452834
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 20D2291447
LAB Type Pharmacy
Facility Name WALGREENS 17364
Street 19 PORTLAND RD
City BRIDGTON
State ME
ZIP 04009
Phone 207 647-3445
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/11/2025
Certificate Expiration Date 10/10/2027
Facility Type Pharmacy
Lab Director FLORENCE F. JELLO

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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