45D2018002 CLIA NUMBER - WALGREENS #04203

Laboratory Demographics

  • CLIA Code: 45D2018002
  • Facility Name: WALGREENS #04203
  • Facility Address: 438 W ILLINOIS RD
    DALLAS, TX
    ZIP 75224
  • Facility Phone: 214 941-1197
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DANIEL B. ASONGWE
  • NPI Number: 1043225014
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2018002
LAB Type Pharmacy
Facility Name WALGREENS #04203
Street 438 W ILLINOIS RD
City DALLAS
State TX
ZIP 75224
Phone 214 941-1197
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/22/2025
Certificate Expiration Date 9/21/2027
Facility Type Pharmacy
Lab Director DANIEL B. ASONGWE

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