39D2221819 CLIA NUMBER - WALGREENS #03663

Laboratory Demographics

  • CLIA Code: 39D2221819
  • Facility Name: WALGREENS #03663
  • Facility Address: 4098 EDGMONT AVE
    BROOKHAVEN, PA
    ZIP 19015
  • Facility Phone: 610 876-8815
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHRISTINE L. WILLIS
  • NPI Number: 1215942206
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 39D2221819
LAB Type Pharmacy
Facility Name WALGREENS #03663
Street 4098 EDGMONT AVE
City BROOKHAVEN
State PA
ZIP 19015
Phone 610 876-8815
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/26/2025
Certificate Expiration Date 4/25/2027
Facility Type Pharmacy
Lab Director CHRISTINE L. WILLIS

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