45D2014760 CLIA NUMBER - WALGREENS #04858

Laboratory Demographics

  • CLIA Code: 45D2014760
  • Facility Name: WALGREENS #04858
  • Facility Address: 6205 WESTCREEK DR
    FORT WORTH, TX
    ZIP 76133
  • Facility Phone: 817 263-0962
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JUSTIN THOMAS
  • NPI Number: 1992126569
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2014760
LAB Type Pharmacy
Facility Name WALGREENS #04858
Street 6205 WESTCREEK DR
City FORT WORTH
State TX
ZIP 76133
Phone 817 263-0962
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/13/2025
Certificate Expiration Date 4/12/2027
Facility Type Pharmacy
Lab Director JUSTIN THOMAS

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