37D2219101 CLIA NUMBER - WALGREENS #10643

Laboratory Demographics

  • CLIA Code: 37D2219101
  • Facility Name: WALGREENS #10643
  • Facility Address: 1119 S MAIN ST
    GROVE, OK
    ZIP 74344
  • Facility Phone: 918 786-6867
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DYLAN HANCIN
  • NPI Number: 1235207242
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 37D2219101
LAB Type Pharmacy
Facility Name WALGREENS #10643
Street 1119 S MAIN ST
City GROVE
State OK
ZIP 74344
Phone 918 786-6867
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/1/2025
Certificate Expiration Date 3/31/2027
Facility Type Pharmacy
Lab Director DYLAN HANCIN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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