45D2061507 CLIA NUMBER - WALGREENS #05211

Laboratory Demographics

  • CLIA Code: 45D2061507
  • Facility Name: WALGREENS #05211
  • Facility Address: 4350 OAK PARK LANE
    FORT WORTH, TX
    ZIP 76109
  • Facility Phone: 817 920-0600
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MATTHEW J. PATAKY
  • NPI Number: 1528482502
  • Taxonomy: 183500000X - Pharmacist

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CLIA Record

Field Name Field Value
CLIA Number 45D2061507
LAB Type Pharmacy
Facility Name WALGREENS #05211
Street 4350 OAK PARK LANE
City FORT WORTH
State TX
ZIP 76109
Phone 817 920-0600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/24/2025
Certificate Expiration Date 5/23/2027
Facility Type Pharmacy
Lab Director MATTHEW J. PATAKY

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