39D2293401 CLIA NUMBER - WALGREENS #03791

Laboratory Demographics

  • CLIA Code: 39D2293401
  • Facility Name: WALGREENS #03791
  • Facility Address: 2014 S BROAD ST
    PHILADELPHIA, PA
    ZIP 19145
  • Facility Phone: 215 551-3818
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KELLEY K. JOHNSON
  • NPI Number: 1124033113
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 39D2293401
LAB Type Pharmacy
Facility Name WALGREENS #03791
Street 2014 S BROAD ST
City PHILADELPHIA
State PA
ZIP 19145
Phone 215 551-3818
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/8/2023
Certificate Expiration Date 11/7/2025
Facility Type Pharmacy
Lab Director KELLEY K. JOHNSON

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This page was last updated on: 6/4/2025