44D2032262 CLIA NUMBER - WALGREENS #11129

Laboratory Demographics

  • CLIA Code: 44D2032262
  • Facility Name: WALGREENS #11129
  • Facility Address: 104 HIGHWAY 52 WEST
    PORTLAND, TN
    ZIP 37148
  • Facility Phone: 615 325-4058
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WENDY L. GULLO
  • NPI Number: 1689856114
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 44D2032262
LAB Type Pharmacy
Facility Name WALGREENS #11129
Street 104 HIGHWAY 52 WEST
City PORTLAND
State TN
ZIP 37148
Phone 615 325-4058
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/25/2025
Certificate Expiration Date 3/24/2027
Facility Type Pharmacy
Lab Director WENDY L. GULLO

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