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39D2221819 CLIA NUMBER - WALGREENS #03663

Laboratory Demographics

CLIA Number: 39D2221819

Facility Name: WALGREENS #03663

Facility Address:
4098 EDGMONT AVE
BROOKHAVEN, PA
ZIP 19015
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Facility Phone Number: 610 876-8815

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1215942206

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 39D2221819
LAB Type Pharmacy
Facility Name WALGREENS #03663
Street 4098 EDGMONT AVE
City BROOKHAVEN
State PA
ZIP 19015
Phone 610 876-8815
CertificateType 4
CertificateEffectiveDate 4/26/2023
CertificateExpirationDate 4/25/2025
FacilityType Waiver

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