33D2240515 CLIA NUMBER - WALGREENS NO 17389

Laboratory Demographics

  • CLIA Code: 33D2240515
  • Facility Name: WALGREENS NO 17389
  • Facility Address: 201 W BROADWAY
    FULTON, NY
    ZIP 13069
  • Facility Phone: 315 598-2380
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. ZEIAD A. FAKHOURI
  • NPI Number: 1720501752
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 33D2240515
LAB Type Physician Office
Facility Name WALGREENS NO 17389
Street 201 W BROADWAY
City FULTON
State NY
ZIP 13069
Phone 315 598-2380
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/20/2021
Certificate Expiration Date 3/26/2027
Facility Type Physician Office
Lab Director DR. ZEIAD A. FAKHOURI

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