33D2188145 CLIA NUMBER - WALGREENS NO 09204

Laboratory Demographics

  • CLIA Code: 33D2188145
  • Facility Name: WALGREENS NO 09204
  • Facility Address: 955 MANOR RD
    STATEN ISLAND, NY
    ZIP 10314
  • Facility Phone: 917 502-9812
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DR. ZEIAD FAKHOURI
  • NPI Number: 1275057846
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 33D2188145
LAB Type Pharmacy
Facility Name WALGREENS NO 09204
Street 955 MANOR RD
City STATEN ISLAND
State NY
ZIP 10314
Phone 917 502-9812
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/13/2020
Certificate Expiration Date 3/26/2027
Facility Type Pharmacy
Lab Director DR. ZEIAD FAKHOURI

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