38D2289882 CLIA NUMBER - WALGREENS 04296

Laboratory Demographics

  • CLIA Code: 38D2289882
  • Facility Name: WALGREENS 04296
  • Facility Address: 3909 SE HOLGATE BLVD
    PORTLAND, OR
    ZIP 97202
  • Facility Phone: 503 777-2893
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RAYMOND TAT
  • NPI Number: 1407861487
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 38D2289882
LAB Type Pharmacy
Facility Name WALGREENS 04296
Street 3909 SE HOLGATE BLVD
City PORTLAND
State OR
ZIP 97202
Phone 503 777-2893
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/18/2025
Certificate Expiration Date 9/17/2027
Facility Type Pharmacy
Lab Director RAYMOND TAT

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