33D2240905 CLIA NUMBER - WALGREENS NO 19500

Laboratory Demographics

  • CLIA Code: 33D2240905
  • Facility Name: WALGREENS NO 19500
  • Facility Address: 76 PIKE ST
    PORT JERVIS, NY
    ZIP 12771
  • Facility Phone: 845 856-8342
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DR. ZEIAD A. FAKHOURI
  • NPI Number: 1023533791
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 33D2240905
LAB Type Pharmacy
Facility Name WALGREENS NO 19500
Street 76 PIKE ST
City PORT JERVIS
State NY
ZIP 12771
Phone 845 856-8342
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/22/2021
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