26D2012563 CLIA NUMBER - WALGREENS #4702

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Laboratory Demographics

CLIA Number: 26D2012563

Facility Name: WALGREENS #4702

Facility Address:
1000 CROSSROADS PL
HIGH RIDGE, MO
ZIP 63049
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Facility Phone Number: 636 376-4785

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1992710925

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	26D2012563
LAB Type	Pharmacy
Facility Name	WALGREENS #4702
Street	1000 CROSSROADS PL
City	HIGH RIDGE
State	MO
ZIP	63049
Phone	636 376-4785
CertificateType	4
CertificateEffectiveDate	10/19/2023
CertificateExpirationDate	10/18/2025
FacilityType	Waiver

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