31D2194917 CLIA NUMBER - WALGREENS # 19396

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Laboratory Demographics

CLIA Number: 31D2194917

Facility Name: WALGREENS # 19396

Facility Address:
231 PROSPECT STREET
SOUTH RIVER, NJ
ZIP 08882
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Facility Phone Number: 267 626-9592

Facility Type: Other - COVID 19 TESTING

Certificate Type: Waiver

NPI Number: 1649795253

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	31D2194917
LAB Type	Other - COVID 19 TESTING
Facility Name	WALGREENS # 19396
Street	231 PROSPECT STREET
City	SOUTH RIVER
State	NJ
ZIP	08882
Phone	267 626-9592
CertificateType	4
CertificateEffectiveDate	10/5/2022
CertificateExpirationDate	10/4/2024
FacilityType	Waiver

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