45D2021963 CLIA NUMBER - WALGREENS # 10139

Laboratory Demographics

  • CLIA Code: 45D2021963
  • Facility Name: WALGREENS # 10139
  • Facility Address: 1305 N MAIN ST
    VIDOR, TX
    ZIP 77662
  • Facility Phone: 409 769-1171
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MAEGAN MOORE
  • NPI Number: 1942236153
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2021963
LAB Type Pharmacy
Facility Name WALGREENS # 10139
Street 1305 N MAIN ST
City VIDOR
State TX
ZIP 77662
Phone 409 769-1171
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/25/2025
Certificate Expiration Date 3/24/2027
Facility Type Pharmacy
Lab Director MAEGAN MOORE

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