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41D2230788 CLIA NUMBER - WALGREENS #19985

Laboratory Demographics

CLIA Number: 41D2230788

Facility Name: WALGREENS #19985

Facility Address:
1665 MINERAL SPRING AVE
NORTH PROVIDENCE, RI
ZIP 02904
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Facility Phone Number: 401 353-3113

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1023531969

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 41D2230788
LAB Type Pharmacy
Facility Name WALGREENS #19985
Street 1665 MINERAL SPRING AVE
City NORTH PROVIDENCE
State RI
ZIP 02904
Phone 401 353-3113
CertificateType 4
CertificateEffectiveDate 7/28/2023
CertificateExpirationDate 7/27/2025
FacilityType Waiver

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