45D2072182 CLIA NUMBER - WALGREENS #04577

Laboratory Demographics

  • CLIA Code: 45D2072182
  • Facility Name: WALGREENS #04577
  • Facility Address: 901 LEGACY DR
    PLANO, TX
    ZIP 75023
  • Facility Phone: 972 517-9744
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BIKASH MAITRA
  • NPI Number: 1376961938
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 45D2072182
LAB Type Pharmacy
Facility Name WALGREENS #04577
Street 901 LEGACY DR
City PLANO
State TX
ZIP 75023
Phone 972 517-9744
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/29/2025
Certificate Expiration Date 7/28/2027
Facility Type Pharmacy
Lab Director BIKASH MAITRA

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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