37D2022854 CLIA NUMBER - WALGREENS # 12714

Laboratory Demographics

  • CLIA Code: 37D2022854
  • Facility Name: WALGREENS # 12714
  • Facility Address: 315 N 193RD EAST AVENUE
    CATOOSA, OK
    ZIP 74015
  • Facility Phone: 918 266-8837
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DYLAN HANCIN
  • NPI Number: 1598909772
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 37D2022854
LAB Type Pharmacy
Facility Name WALGREENS # 12714
Street 315 N 193RD EAST AVENUE
City CATOOSA
State OK
ZIP 74015
Phone 918 266-8837
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/23/2025
Certificate Expiration Date 3/22/2027
Facility Type Pharmacy
Lab Director DYLAN HANCIN

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