45D2027962 CLIA NUMBER - WALGREENS #4054

Laboratory Demographics

  • CLIA Code: 45D2027962
  • Facility Name: WALGREENS #4054
  • Facility Address: 1050 W SHADY GROVE RD
    IRVING, TX
    ZIP 75060
  • Facility Phone: 972 254-0305
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SULEIMAN MOHAMUD
  • NPI Number: 1730194762
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2027962
LAB Type Pharmacy
Facility Name WALGREENS #4054
Street 1050 W SHADY GROVE RD
City IRVING
State TX
ZIP 75060
Phone 972 254-0305
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/30/2025
Certificate Expiration Date 7/29/2027
Facility Type Pharmacy
Lab Director SULEIMAN MOHAMUD

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