33D2211200 CLIA NUMBER - WALGREENS #03859

Laboratory Demographics

  • CLIA Code: 33D2211200
  • Facility Name: WALGREENS #03859
  • Facility Address: 485 BROADWAY
    DEPEW, NY
    ZIP 14043
  • Facility Phone: 716 683-7971
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DR. ZEIAD FAKHOURI
  • NPI Number: 1174530125
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 33D2211200
LAB Type Pharmacy
Facility Name WALGREENS #03859
Street 485 BROADWAY
City DEPEW
State NY
ZIP 14043
Phone 716 683-7971
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/26/2021
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