44D2032432 CLIA NUMBER - WALGREENS #9430

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Laboratory Demographics

CLIA Number: 44D2032432

Facility Name: WALGREENS #9430

Facility Address:
132 E BROADWAY BLVD
JEFFERSON CITY, TN
ZIP 37760
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Facility Phone Number: 865 471-0548

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1750396784

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	44D2032432
LAB Type	Pharmacy
Facility Name	WALGREENS #9430
Street	132 E BROADWAY BLVD
City	JEFFERSON CITY
State	TN
ZIP	37760
Phone	865 471-0548
CertificateType	4
CertificateEffectiveDate	5/6/2023
CertificateExpirationDate	5/5/2025
FacilityType	Waiver

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