34D2046056 CLIA NUMBER - WALGREENS #11803

Laboratory Demographics

  • CLIA Code: 34D2046056
  • Facility Name: WALGREENS #11803
  • Facility Address: 801 MEBANE OAKS RD
    MEBANE, NC
    ZIP 27302
  • Facility Phone: 919 563-5521
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SOUPHIDA K. CHANTHAPHAVONG
  • NPI Number: 1023321015
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 34D2046056
LAB Type Pharmacy
Facility Name WALGREENS #11803
Street 801 MEBANE OAKS RD
City MEBANE
State NC
ZIP 27302
Phone 919 563-5521
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/26/2025
Certificate Expiration Date 3/25/2027
Facility Type Pharmacy
Lab Director SOUPHIDA K. CHANTHAPHAVONG

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