38D2224683 CLIA NUMBER - WALGREENS #11173

Laboratory Demographics

  • CLIA Code: 38D2224683
  • Facility Name: WALGREENS #11173
  • Facility Address: 4760 LIBERTY RD S
    SALEM, OR
    ZIP 97302
  • Facility Phone: 503 428-5098
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SAMUEL J. RAWLINS
  • NPI Number: 1467630780
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 38D2224683
LAB Type Pharmacy
Facility Name WALGREENS #11173
Street 4760 LIBERTY RD S
City SALEM
State OR
ZIP 97302
Phone 503 428-5098
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/14/2025
Certificate Expiration Date 5/13/2027
Facility Type Pharmacy
Lab Director SAMUEL J. RAWLINS

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