45D2022620 CLIA NUMBER - WALGREENS #04268

Laboratory Demographics

  • CLIA Code: 45D2022620
  • Facility Name: WALGREENS #04268
  • Facility Address: 3809 E BELKNAP STREET
    FORT WORTH, TX
    ZIP 76111
  • Facility Phone: 817 834-7283
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SUSAN PHAM
  • NPI Number: 1750396719
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2022620
LAB Type Pharmacy
Facility Name WALGREENS #04268
Street 3809 E BELKNAP STREET
City FORT WORTH
State TX
ZIP 76111
Phone 817 834-7283
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/20/2025
Certificate Expiration Date 10/19/2027
Facility Type Pharmacy
Lab Director SUSAN PHAM

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