32D2223411 CLIA NUMBER - WALGREENS #04510

Laboratory Demographics

  • CLIA Code: 32D2223411
  • Facility Name: WALGREENS #04510
  • Facility Address: 4221 E MAIN ST
    FARMINGTON, NM
    ZIP 87402
  • Facility Phone: 505 325-1749
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEFF BETTNER
  • NPI Number: 1710993118
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 32D2223411
LAB Type Pharmacy
Facility Name WALGREENS #04510
Street 4221 E MAIN ST
City FARMINGTON
State NM
ZIP 87402
Phone 505 325-1749
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/6/2025
Certificate Expiration Date 5/5/2027
Facility Type Pharmacy
Lab Director JEFF BETTNER

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