26D2012634 CLIA NUMBER - WALGREENS #04824

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Laboratory Demographics

CLIA Number: 26D2012634

Facility Name: WALGREENS #04824

Facility Address:
12098 LUSHER ROAD
SAINT LOUIS, MO
ZIP 63138
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Facility Phone Number: 314 355-0500

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1013922251

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	26D2012634
LAB Type	Pharmacy
Facility Name	WALGREENS #04824
Street	12098 LUSHER ROAD
City	SAINT LOUIS
State	MO
ZIP	63138
Phone	314 355-0500
CertificateType	4
CertificateEffectiveDate	3/12/2023
CertificateExpirationDate	3/11/2025
FacilityType	Waiver

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