45D2022163 CLIA NUMBER - WALGREENS # 06996

Laboratory Demographics

  • CLIA Code: 45D2022163
  • Facility Name: WALGREENS # 06996
  • Facility Address: 4200 E LANCASTER AVENUE
    FORT WORTH, TX
    ZIP 76103
  • Facility Phone: 817 413-7442
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SAMPSON OGBUCHI-SANTANA
  • NPI Number: 1770598674
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2022163
LAB Type Pharmacy
Facility Name WALGREENS # 06996
Street 4200 E LANCASTER AVENUE
City FORT WORTH
State TX
ZIP 76103
Phone 817 413-7442
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/4/2023
Certificate Expiration Date 8/3/2025
Facility Type Pharmacy
Lab Director SAMPSON OGBUCHI-SANTANA

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This page was last updated on: 6/4/2025