37D2012064 CLIA NUMBER - WALGREENS #07698

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Laboratory Demographics

CLIA Number: 37D2012064

Facility Name: WALGREENS #07698

Facility Address:
2300 N 14TH STREET
PONCA CITY, OK
ZIP 74601
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Facility Phone Number: 580 767-1584

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1255346235

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	37D2012064
LAB Type	Pharmacy
Facility Name	WALGREENS #07698
Street	2300 N 14TH STREET
City	PONCA CITY
State	OK
ZIP	74601
Phone	580 767-1584
CertificateType	4
CertificateEffectiveDate	4/2/2023
CertificateExpirationDate	4/1/2025
FacilityType	Waiver

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