45D2021958 CLIA NUMBER - WALGREENS #09574

Laboratory Demographics

  • CLIA Code: 45D2021958
  • Facility Name: WALGREENS #09574
  • Facility Address: 610 E VILLA MARIA RD
    BRYAN, TX
    ZIP 77802
  • Facility Phone: 979 779-2006
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AIMEE LUSSON
  • NPI Number: 1043595366
  • Taxonomy: 183500000X - Pharmacist

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CLIA Record

Field Name Field Value
CLIA Number 45D2021958
LAB Type Pharmacy
Facility Name WALGREENS #09574
Street 610 E VILLA MARIA RD
City BRYAN
State TX
ZIP 77802
Phone 979 779-2006
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/23/2025
Certificate Expiration Date 3/22/2027
Facility Type Pharmacy
Lab Director AIMEE LUSSON

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