32D2011775 CLIA NUMBER - WALGREENS #05158

Laboratory Demographics

  • CLIA Code: 32D2011775
  • Facility Name: WALGREENS #05158
  • Facility Address: 4051 SOUTHERN BLVD SE
    RIO RANCHO, NM
    ZIP 87124
  • Facility Phone: 505 892-6690
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEFF BETTNER
  • NPI Number: 1528073426
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 32D2011775
LAB Type Pharmacy
Facility Name WALGREENS #05158
Street 4051 SOUTHERN BLVD SE
City RIO RANCHO
State NM
ZIP 87124
Phone 505 892-6690
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/19/2025
Certificate Expiration Date 5/18/2027
Facility Type Pharmacy
Lab Director JEFF BETTNER

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