40D2255644 CLIA NUMBER - WALGREENS # 12874

Laboratory Demographics

  • CLIA Code: 40D2255644
  • Facility Name: WALGREENS # 12874
  • Facility Address: 2030 BLVD LUIS A FERRE
    PONCE, PR
    ZIP 00717
  • Facility Phone: 787 709-4774
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CELINES RODRIGUEZ
  • NPI Number: 1871508770
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 40D2255644
LAB Type Physician Office
Facility Name WALGREENS # 12874
Street 2030 BLVD LUIS A FERRE
City PONCE
State PR
ZIP 00717
Phone 787 709-4774
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/16/2024
Certificate Expiration Date 3/15/2026
Facility Type Physician Office
Lab Director CELINES RODRIGUEZ

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