45D2021959 CLIA NUMBER - WALGREENS #03958

Laboratory Demographics

  • CLIA Code: 45D2021959
  • Facility Name: WALGREENS #03958
  • Facility Address: 4930 GULFWAY DR
    PORT ARTHUR, TX
    ZIP 77642
  • Facility Phone: 409 982-1654
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: THUY K. LE
  • NPI Number: 1790097186
  • Taxonomy: 261QC1500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2021959
LAB Type Pharmacy
Facility Name WALGREENS #03958
Street 4930 GULFWAY DR
City PORT ARTHUR
State TX
ZIP 77642
Phone 409 982-1654
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2025
Certificate Expiration Date 3/21/2027
Facility Type Pharmacy
Lab Director THUY K. LE

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