45D2011762 CLIA NUMBER - WALGREENS #04704

Laboratory Demographics

  • CLIA Code: 45D2011762
  • Facility Name: WALGREENS #04704
  • Facility Address: 4501 GUADALUPE ST
    AUSTIN, TX
    ZIP 78751
  • Facility Phone: 512 323-6098
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALICE JONES
  • NPI Number: 1689689663
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2011762
LAB Type Pharmacy
Facility Name WALGREENS #04704
Street 4501 GUADALUPE ST
City AUSTIN
State TX
ZIP 78751
Phone 512 323-6098
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/21/2025
Certificate Expiration Date 6/20/2027
Facility Type Pharmacy
Lab Director ALICE JONES

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