45D2022206 CLIA NUMBER - WALGREENS # 05961

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Laboratory Demographics

CLIA Number: 45D2022206

Facility Name: WALGREENS # 05961

Facility Address:
921 HENDERSON ST
FORT WORTH, TX
ZIP 76102
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Facility Phone Number: 817 885-8563

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1669487641

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	45D2022206
LAB Type	Pharmacy
Facility Name	WALGREENS # 05961
Street	921 HENDERSON ST
City	FORT WORTH
State	TX
ZIP	76102
Phone	817 885-8563
CertificateType	4
CertificateEffectiveDate	6/1/2023
CertificateExpirationDate	5/31/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024