31D2035876 CLIA NUMBER - WALGREENS#06620

Laboratory Demographics

  • CLIA Code: 31D2035876
  • Facility Name: WALGREENS#06620
  • Facility Address: 120 E 1ST AVE
    ROSELLE, NJ
    ZIP 07203
  • Facility Phone: 908 241-0476
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMANDA SOUROUR
  • NPI Number: 1992710883
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 31D2035876
LAB Type Pharmacy
Facility Name WALGREENS#06620
Street 120 E 1ST AVE
City ROSELLE
State NJ
ZIP 07203
Phone 908 241-0476
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/1/2025
Certificate Expiration Date 3/31/2027
Facility Type Pharmacy
Lab Director AMANDA SOUROUR

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