39D2292435 CLIA NUMBER - WALGREENS #07336

Laboratory Demographics

  • CLIA Code: 39D2292435
  • Facility Name: WALGREENS #07336
  • Facility Address: 1617 JOHN F KENNEDY BLVD
    PHILADELPHIA, PA
    ZIP 19103
  • Facility Phone: 215 561-1316
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PHILIP J. MACENO
  • NPI Number: 1598770489
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 39D2292435
LAB Type Pharmacy
Facility Name WALGREENS #07336
Street 1617 JOHN F KENNEDY BLVD
City PHILADELPHIA
State PA
ZIP 19103
Phone 215 561-1316
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/25/2023
Certificate Expiration Date 10/24/2025
Facility Type Pharmacy
Lab Director PHILIP J. MACENO

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