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33D2212524 CLIA NUMBER - WALGREENS #11778

Laboratory Demographics

CLIA Number: 33D2212524

Facility Name: WALGREENS #11778

Facility Address:
286 W MAIN ST
PATCHOGUE, NY
ZIP 11772
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Facility Phone Number: 631 278-2948

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1487669560

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 33D2212524
LAB Type Pharmacy
Facility Name WALGREENS #11778
Street 286 W MAIN ST
City PATCHOGUE
State NY
ZIP 11772
Phone 631 278-2948
CertificateType 4
CertificateEffectiveDate 2/4/2021
CertificateExpirationDate 3/26/2027
FacilityType Waiver

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