45D2013150 CLIA NUMBER - WALGREENS #04189

Laboratory Demographics

  • CLIA Code: 45D2013150
  • Facility Name: WALGREENS #04189
  • Facility Address: 6244 LAKE WORTH BLVD
    FORT WORTH, TX
    ZIP 76135
  • Facility Phone: 817 238-0385
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KAYE HRUBES
  • NPI Number: 1215942255
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2013150
LAB Type Pharmacy
Facility Name WALGREENS #04189
Street 6244 LAKE WORTH BLVD
City FORT WORTH
State TX
ZIP 76135
Phone 817 238-0385
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/8/2024
Certificate Expiration Date 3/7/2026
Facility Type Pharmacy
Lab Director KAYE HRUBES

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