45D2012864 CLIA NUMBER - WALGREENS #06694

Laboratory Demographics

  • CLIA Code: 45D2012864
  • Facility Name: WALGREENS #06694
  • Facility Address: 2161 E 42ND ST
    ODESSA, TX
    ZIP 79762
  • Facility Phone: 432 367-0738
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AHMED JALLAD
  • NPI Number: 1306851209
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2012864
LAB Type Pharmacy
Facility Name WALGREENS #06694
Street 2161 E 42ND ST
City ODESSA
State TX
ZIP 79762
Phone 432 367-0738
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/12/2025
Certificate Expiration Date 4/11/2027
Facility Type Pharmacy
Lab Director AHMED JALLAD

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