31D2035172 CLIA NUMBER - WALGREENS#13702

Laboratory Demographics

  • CLIA Code: 31D2035172
  • Facility Name: WALGREENS#13702
  • Facility Address: 397 ROUTE 46 W
    FAIRFIELD, NJ
    ZIP 07004
  • Facility Phone: 862 210-3980
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SUSAN M. KELLER
  • NPI Number: 1629210687
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 31D2035172
LAB Type Pharmacy
Facility Name WALGREENS#13702
Street 397 ROUTE 46 W
City FAIRFIELD
State NJ
ZIP 07004
Phone 862 210-3980
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/12/2024
Certificate Expiration Date 1/11/2026
Facility Type Pharmacy
Lab Director SUSAN M. KELLER

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