45D2011759 CLIA NUMBER - WALGREENS #09143

Laboratory Demographics

  • CLIA Code: 45D2011759
  • Facility Name: WALGREENS #09143
  • Facility Address: 504 HIGHWAY 71 W
    BASTROP, TX
    ZIP 78602
  • Facility Phone: 512 321-4008
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AIMEE LUSSON
  • NPI Number: 1255346342
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2011759
LAB Type Pharmacy
Facility Name WALGREENS #09143
Street 504 HIGHWAY 71 W
City BASTROP
State TX
ZIP 78602
Phone 512 321-4008
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/8/2025
Certificate Expiration Date 3/7/2027
Facility Type Pharmacy
Lab Director AIMEE LUSSON

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