38D2218313 CLIA NUMBER - WALGREENS #12290

Laboratory Demographics

  • CLIA Code: 38D2218313
  • Facility Name: WALGREENS #12290
  • Facility Address: 1704 E MAIN STREET
    COTTAGE GROVE, OR
    ZIP 97424
  • Facility Phone: 541 942-2224
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JENNIFER R. BURCHAM
  • NPI Number: 1265678650
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 38D2218313
LAB Type Pharmacy
Facility Name WALGREENS #12290
Street 1704 E MAIN STREET
City COTTAGE GROVE
State OR
ZIP 97424
Phone 541 942-2224
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 JENNIFER R. BURCHAM

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