45D2012593 CLIA NUMBER - WALGREENS # 06358

Laboratory Demographics

  • CLIA Code: 45D2012593
  • Facility Name: WALGREENS # 06358
  • Facility Address: 5415 S BROADWAY AVE
    TYLER, TX
    ZIP 75703
  • Facility Phone: 903 939-9298
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AIMEE LUSSON
  • NPI Number: 1942624457
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 45D2012593
LAB Type Pharmacy
Facility Name WALGREENS # 06358
Street 5415 S BROADWAY AVE
City TYLER
State TX
ZIP 75703
Phone 903 939-9298
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