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44D2235249 CLIA NUMBER - WALGREENS #17669

Laboratory Demographics

CLIA Number: 44D2235249

Facility Name: WALGREENS #17669

Facility Address:
318 NORTH CHANCERY STREET
MC MINNVILLE, TN
ZIP 37110
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Facility Phone Number: 931 473-2235

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1043225089

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 44D2235249
LAB Type Pharmacy
Facility Name WALGREENS #17669
Street 318 NORTH CHANCERY STREET
City MC MINNVILLE
State TN
ZIP 37110
Phone 931 473-2235
CertificateType 4
CertificateEffectiveDate 9/8/2023
CertificateExpirationDate 9/7/2025
FacilityType Waiver

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