33D2240520 CLIA NUMBER - WALGREENS NO 17603

Laboratory Demographics

  • CLIA Code: 33D2240520
  • Facility Name: WALGREENS NO 17603
  • Facility Address: 17 EAST STATE STREET
    ILION, NY
    ZIP 13357
  • Facility Phone: 315 894-9995
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DR. ZEIAD A. FAKHOURI
  • NPI Number: 1770007742
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 33D2240520
LAB Type Pharmacy
Facility Name WALGREENS NO 17603
Street 17 EAST STATE STREET
City ILION
State NY
ZIP 13357
Phone 315 894-9995
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 Pharmacy
Lab Director DR. ZEIAD A. FAKHOURI

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