38D2288242 CLIA NUMBER - WALGREENS 12901

Laboratory Demographics

  • CLIA Code: 38D2288242
  • Facility Name: WALGREENS 12901
  • Facility Address: 3411 BROADWAY AVE
    NORTH BEND, OR
    ZIP 97459
  • Facility Phone: 541 756-0118
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WENDI RJ LISZKA
  • NPI Number: 1295081230
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 38D2288242
LAB Type Pharmacy
Facility Name WALGREENS 12901
Street 3411 BROADWAY AVE
City NORTH BEND
State OR
ZIP 97459
Phone 541 756-0118
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/23/2025
Certificate Expiration Date 8/22/2027
Facility Type Pharmacy
Lab Director WENDI RJ LISZKA

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