34D2012991 CLIA NUMBER - WALGREENS #07401

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Laboratory Demographics

CLIA Number: 34D2012991

Facility Name: WALGREENS #07401

Facility Address:
13720 INDEPENDENCE BOULEVARD
INDIAN TRAIL, NC
ZIP 28079
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Facility Phone Number: 704 821-1589

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1578578670

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	34D2012991
LAB Type	Pharmacy
Facility Name	WALGREENS #07401
Street	13720 INDEPENDENCE BOULEVARD
City	INDIAN TRAIL
State	NC
ZIP	28079
Phone	704 821-1589
CertificateType	4
CertificateEffectiveDate	4/8/2023
CertificateExpirationDate	4/7/2025
FacilityType	Waiver

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