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33D2243386 CLIA NUMBER - WALGREENS NO 11209

Laboratory Demographics

CLIA Number: 33D2243386

Facility Name: WALGREENS NO 11209

Facility Address:
2850 RTE 112
MEDFORD, NY
ZIP 11763
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Facility Phone Number: 631 696-4018

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1790067106

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 33D2243386
LAB Type Pharmacy
Facility Name WALGREENS NO 11209
Street 2850 RTE 112
City MEDFORD
State NY
ZIP 11763
Phone 631 696-4018
CertificateType 4
CertificateEffectiveDate 11/18/2021
CertificateExpirationDate 3/26/2027
FacilityType Waiver

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