45D2020640 CLIA NUMBER - WALGREENS #12355

Laboratory Demographics

  • CLIA Code: 45D2020640
  • Facility Name: WALGREENS #12355
  • Facility Address: 1790 TEXAS AVE
    BRIDGE CITY, TX
    ZIP 77611
  • Facility Phone: 409 792-0597
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHELSEA D. BENNETT-DEJEAN
  • NPI Number: 1598914616
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2020640
LAB Type Pharmacy
Facility Name WALGREENS #12355
Street 1790 TEXAS AVE
City BRIDGE CITY
State TX
ZIP 77611
Phone 409 792-0597
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/25/2025
Certificate Expiration Date 5/24/2027
Facility Type Pharmacy
Lab Director CHELSEA D. BENNETT-DEJEAN

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