42D2288815 CLIA NUMBER - WALGREENS 06136

Laboratory Demographics

CLIA Number: 42D2288815

Facility Name: WALGREENS 06136

Facility Address:
4467 DEVINE STREET
COLUMBIA, SC
ZIP 29205
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Facility Phone Number: 803 787-2527

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1003821190

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	42D2288815
LAB Type	Pharmacy
Facility Name	WALGREENS 06136
Street	4467 DEVINE STREET
City	COLUMBIA
State	SC
ZIP	29205
Phone	803 787-2527
CertificateType	4
CertificateEffectiveDate	8/31/2023
CertificateExpirationDate	8/30/2025
FacilityType	Waiver

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