33D2294194 CLIA NUMBER - WALGREENS NO 04687

Laboratory Demographics

  • CLIA Code: 33D2294194
  • Facility Name: WALGREENS NO 04687
  • Facility Address: 1580 ROUTE 112
    MEDFORD, NY
    ZIP 11763
  • Facility Phone: 631 207-9234
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DR. ZEIAD A. FAKHOURI
  • NPI Number: 1720093875
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 33D2294194
LAB Type Pharmacy
Facility Name WALGREENS NO 04687
Street 1580 ROUTE 112
City MEDFORD
State NY
ZIP 11763
Phone 631 207-9234
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/20/2023
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