34D2031176 CLIA NUMBER - WALGREENS #2530

Laboratory Demographics

  • CLIA Code: 34D2031176
  • Facility Name: WALGREENS #2530
  • Facility Address: 5098 SOUTHPORT SUPPLY RD SE
    SOUTHPORT, NC
    ZIP 28461
  • Facility Phone: 910 457-1463
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TRAVIS FULLER
  • NPI Number: 1669771796
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 34D2031176
LAB Type Pharmacy
Facility Name WALGREENS #2530
Street 5098 SOUTHPORT SUPPLY RD SE
City SOUTHPORT
State NC
ZIP 28461
Phone 910 457-1463
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/16/2025
Certificate Expiration Date 8/15/2027
Facility Type Pharmacy
Lab Director TRAVIS FULLER

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This page was last updated on: 9/29/2025