31D2035170 CLIA NUMBER - WALGREENS#12792

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Laboratory Demographics

CLIA Number: 31D2035170

Facility Name: WALGREENS#12792

Facility Address:
350 PREAKNESS AVE
PATERSON, NJ
ZIP 07502
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Facility Phone Number: 973 595-1075

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1659679280

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	31D2035170
LAB Type	Pharmacy
Facility Name	WALGREENS#12792
Street	350 PREAKNESS AVE
City	PATERSON
State	NJ
ZIP	07502
Phone	973 595-1075
CertificateType	4
CertificateEffectiveDate	12/14/2022
CertificateExpirationDate	12/13/2024
FacilityType	Waiver

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