38D2287303 CLIA NUMBER - WALGREENS 05647

Laboratory Demographics

  • CLIA Code: 38D2287303
  • Facility Name: WALGREENS 05647
  • Facility Address: 6116 NE M L KING BLVD
    PORTLAND, OR
    ZIP 97211
  • Facility Phone: 503 282-0689
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: EMILY DEVOE MATTIN
  • NPI Number: 1508871591
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 38D2287303
LAB Type Pharmacy
Facility Name WALGREENS 05647
Street 6116 NE M L KING BLVD
City PORTLAND
State OR
ZIP 97211
Phone 503 282-0689
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/11/2025
Certificate Expiration Date 8/10/2027
Facility Type Pharmacy
Lab Director EMILY DEVOE MATTIN

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