45D2028018 CLIA NUMBER - WALGREENS #09400

Laboratory Demographics

  • CLIA Code: 45D2028018
  • Facility Name: WALGREENS #09400
  • Facility Address: 3004 NORTH ST
    NACOGDOCHES, TX
    ZIP 75965
  • Facility Phone: 936 569-0183
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AIMEE LUSSON
  • NPI Number: 1619982709
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2028018
LAB Type Pharmacy
Facility Name WALGREENS #09400
Street 3004 NORTH ST
City NACOGDOCHES
State TX
ZIP 75965
Phone 936 569-0183
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/13/2025
Certificate Expiration Date 4/12/2027
Facility Type Pharmacy
Lab Director AIMEE LUSSON

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