26D2012634 CLIA NUMBER - WALGREENS #04824

Laboratory Demographics

  • CLIA Code: 26D2012634
  • Facility Name: WALGREENS #04824
  • Facility Address: 12098 LUSHER ROAD
    SAINT LOUIS, MO
    ZIP 63138
  • Facility Phone: 314 355-0500
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PATRICIA TAVARES
  • NPI Number: 1013922251
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 26D2012634
LAB Type Pharmacy
Facility Name WALGREENS #04824
Street 12098 LUSHER ROAD
City SAINT LOUIS
State MO
ZIP 63138
Phone 314 355-0500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/12/2025
Certificate Expiration Date 3/11/2027
Facility Type Pharmacy
Lab Director PATRICIA TAVARES

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