32D2031842 CLIA NUMBER - WALGREENS #12751

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Laboratory Demographics

CLIA Number: 32D2031842

Facility Name: WALGREENS #12751

Facility Address:
811 PASEO PUEBLO DEL SUR
TAOS, NM
ZIP 87571
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Facility Phone Number: 575 758-1704

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1952534125

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	32D2031842
LAB Type	Pharmacy
Facility Name	WALGREENS #12751
Street	811 PASEO PUEBLO DEL SUR
City	TAOS
State	NM
ZIP	87571
Phone	575 758-1704
CertificateType	4
CertificateEffectiveDate	5/19/2023
CertificateExpirationDate	5/18/2025
FacilityType	Waiver

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