31D2287350 CLIA NUMBER - WALGREENS 17731

Laboratory Demographics

  • CLIA Code: 31D2287350
  • Facility Name: WALGREENS 17731
  • Facility Address: 199 E RIDGEWOOD AVE
    RIDGEWOOD, NJ
    ZIP 07450
  • Facility Phone: 201 447-3424
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARY E. TAKHTOVICH
  • NPI Number: 1891219853
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 31D2287350
LAB Type Pharmacy
Facility Name WALGREENS 17731
Street 199 E RIDGEWOOD AVE
City RIDGEWOOD
State NJ
ZIP 07450
Phone 201 447-3424
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/14/2023
Certificate Expiration Date 8/13/2025
Facility Type Pharmacy
Lab Director MARY E. TAKHTOVICH

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This page was last updated on: 6/4/2025