45D2013150 CLIA NUMBER - WALGREENS #04189

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Laboratory Demographics

CLIA Number: 45D2013150

Facility Name: WALGREENS #04189

Facility Address:
6244 LAKE WORTH BLVD
FORT WORTH, TX
ZIP 76135
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Facility Phone Number: 817 238-0385

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1215942255

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

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
CertificateType	4
CertificateEffectiveDate	3/8/2024
CertificateExpirationDate	3/7/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024