31D2035140 CLIA NUMBER - WALGREENS#12064

Laboratory Demographics

  • CLIA Code: 31D2035140
  • Facility Name: WALGREENS#12064
  • Facility Address: 361 BERGEN ST
    NEWARK, NJ
    ZIP 07103
  • Facility Phone: (973) 622-3021
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MYROSLAVA PALADYAN
  • NPI Number: 1255573036
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 31D2035140
LAB Type Pharmacy
Facility Name WALGREENS#12064
Street 361 BERGEN ST
City NEWARK
State NJ
ZIP 07103
Phone 9736223021
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/25/2025
Certificate Expiration Date 9/24/2027
Facility Type Pharmacy
Lab Director MYROSLAVA PALADYAN

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This page was last updated on: 5/18/2026