33D2243386 CLIA NUMBER - WALGREENS NO 11209

Laboratory Demographics

  • CLIA Code: 33D2243386
  • Facility Name: WALGREENS NO 11209
  • Facility Address: 2850 RTE 112
    MEDFORD, NY
    ZIP 11763
  • Facility Phone: 631 696-4018
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DR. ZEIAD A. FAKHOURI
  • NPI Number: 1790067106
  • Taxonomy: 333600000X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/18/2021
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