26D2012631 CLIA NUMBER - WALGREENS #04090

Laboratory Demographics

  • CLIA Code: 26D2012631
  • Facility Name: WALGREENS #04090
  • Facility Address: 2920 HIGHWAY K
    O FALLON, MO
    ZIP 63368
  • Facility Phone: 636 240-5077
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANGELA M. QUINN
  • NPI Number: 1538174552
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 26D2012631
LAB Type Pharmacy
Facility Name WALGREENS #04090
Street 2920 HIGHWAY K
City O FALLON
State MO
ZIP 63368
Phone 636 240-5077
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/21/2023
Certificate Expiration Date 9/20/2025
Facility Type Pharmacy
Lab Director ANGELA M. QUINN

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