45D2011765 CLIA NUMBER - WALGREENS #15672

Laboratory Demographics

  • CLIA Code: 45D2011765
  • Facility Name: WALGREENS #15672
  • Facility Address: 1920 EAST RIVERSIDE DR,BLDG B
    AUSTIN, TX
    ZIP 78741
  • Facility Phone: 512 326-5228
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JACQUELYN M. HARCUS
  • NPI Number: 1821003849
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2011765
LAB Type Pharmacy
Facility Name WALGREENS #15672
Street 1920 EAST RIVERSIDE DR,BLDG B
City AUSTIN
State TX
ZIP 78741
Phone 512 326-5228
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/30/2025
Certificate Expiration Date 6/29/2027
Facility Type Pharmacy
Lab Director JACQUELYN M. HARCUS

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