38D2289500 CLIA NUMBER - WALGREENS 04257

Laboratory Demographics

  • CLIA Code: 38D2289500
  • Facility Name: WALGREENS 04257
  • Facility Address: 4380 COMMERCIAL ST SE
    SALEM, OR
    ZIP 97302
  • Facility Phone: 503 399-8148
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GAVIN J. FAST
  • NPI Number: 1871508853
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 38D2289500
LAB Type Pharmacy
Facility Name WALGREENS 04257
Street 4380 COMMERCIAL ST SE
City SALEM
State OR
ZIP 97302
Phone 503 399-8148
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/12/2023
Certificate Expiration Date 9/11/2025
Facility Type Pharmacy
Lab Director GAVIN J. FAST

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This page was last updated on: 6/4/2025