33D2212524 CLIA NUMBER - WALGREENS #11778

Laboratory Demographics

  • CLIA Code: 33D2212524
  • Facility Name: WALGREENS #11778
  • Facility Address: 286 W MAIN ST
    PATCHOGUE, NY
    ZIP 11772
  • Facility Phone: 631 278-2948
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DR. ZEIAD FAKHOURI
  • NPI Number: 1487669560
  • Taxonomy: 333600000X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/4/2021
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