45D2069040 CLIA NUMBER - WALGREENS #05767

Laboratory Demographics

  • CLIA Code: 45D2069040
  • Facility Name: WALGREENS #05767
  • Facility Address: 2204 SOUTHMORE AVE
    PASADENA, TX
    ZIP 77502
  • Facility Phone: 713 473-8267
  • Facility Type: Other - COVID-19 TESTING SITE
  • Facility Type: Waiver
  • Lab Director: CHANTELLE A. PARKER
  • NPI Number: 1114934114
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2069040
LAB Type Other - COVID-19 TESTING SITE
Facility Name WALGREENS #05767
Street 2204 SOUTHMORE AVE
City PASADENA
State TX
ZIP 77502
Phone 713 473-8267
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/10/2024
Certificate Expiration Date 4/9/2026
Facility Type Other - COVID-19 TESTING SITE
Lab Director CHANTELLE A. PARKER

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