38D2289925 CLIA NUMBER - WALGREENS 04495

Laboratory Demographics

CLIA Number: 38D2289925

Facility Name: WALGREENS 04495

Facility Address:
2103 W BURNSIDE ST
PORTLAND, OR
ZIP 97210
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Facility Phone Number: 503 295-6480

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1316952393

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name Field Value
CLIA Number 38D2289925
LAB Type Pharmacy
Facility Name WALGREENS 04495
Street 2103 W BURNSIDE ST
City PORTLAND
State OR
ZIP 97210
Phone 503 295-6480
CertificateType 4
CertificateEffectiveDate 9/18/2023
CertificateExpirationDate 9/17/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024