34D2031197 CLIA NUMBER - WALGREENS #13854

Laboratory Demographics

  • CLIA Code: 34D2031197
  • Facility Name: WALGREENS #13854
  • Facility Address: 1103 NORTH BREAZEALE AVENUE
    MOUNT OLIVE, NC
    ZIP 28365
  • Facility Phone: 919 658-8510
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RONALD J. PATE
  • NPI Number: 1356633531
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 34D2031197
LAB Type Pharmacy
Facility Name WALGREENS #13854
Street 1103 NORTH BREAZEALE AVENUE
City MOUNT OLIVE
State NC
ZIP 28365
Phone 919 658-8510
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/23/2025
Certificate Expiration Date 4/22/2027
Facility Type Pharmacy
Lab Director RONALD J. PATE

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