37D2012805 CLIA NUMBER - WALGREENS #04111

Laboratory Demographics

  • CLIA Code: 37D2012805
  • Facility Name: WALGREENS #04111
  • Facility Address: 12240 N MAY AVE
    OKLAHOMA CITY, OK
    ZIP 73120
  • Facility Phone: (405) 751-1938
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DYLAN M. HANCIN
  • NPI Number: 1790790764
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 37D2012805
LAB Type Pharmacy
Facility Name WALGREENS #04111
Street 12240 N MAY AVE
City OKLAHOMA CITY
State OK
ZIP 73120
Phone 4057511938
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/17/2025
Certificate Expiration Date 2/16/2027
Facility Type Pharmacy
Lab Director DYLAN M. HANCIN

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This page was last updated on: 5/18/2026