45D2055858 CLIA NUMBER - WALGREENS#6047

Laboratory Demographics

  • CLIA Code: 45D2055858
  • Facility Name: WALGREENS#6047
  • Facility Address: 541 TROPHY LAKE DR
    TROPHY CLUB, TX
    ZIP 76262
  • Facility Phone: 682 831-1650
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: THOMAS R. OBRZUT
  • NPI Number: 1366028995
  • Taxonomy: 3336M0002X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2055858
LAB Type Pharmacy
Facility Name WALGREENS#6047
Street 541 TROPHY LAKE DR
City TROPHY CLUB
State TX
ZIP 76262
Phone 682 831-1650
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/4/2025
Certificate Expiration Date 8/3/2027
Facility Type Pharmacy
Lab Director THOMAS R. OBRZUT

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