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33D2188145 CLIA NUMBER - WALGREENS NO 09204

Laboratory Demographics

CLIA Number: 33D2188145

Facility Name: WALGREENS NO 09204

Facility Address:
955 MANOR RD
STATEN ISLAND, NY
ZIP 10314
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Facility Phone Number: 917 502-9812

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1275057846

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 33D2188145
LAB Type Pharmacy
Facility Name WALGREENS NO 09204
Street 955 MANOR RD
City STATEN ISLAND
State NY
ZIP 10314
Phone 917 502-9812
CertificateType 4
CertificateEffectiveDate 7/13/2020
CertificateExpirationDate 3/26/2027
FacilityType Waiver

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