45D2072447 CLIA NUMBER - WALGREENS #11212

Laboratory Demographics

  • CLIA Code: 45D2072447
  • Facility Name: WALGREENS #11212
  • Facility Address: 2126 US HIGHWAY 79 S
    HENDERSON, TX
    ZIP 75654
  • Facility Phone: 903 655-7561
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RAFAEL DEVRAE VEASY
  • NPI Number: 1205033057
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2072447
LAB Type Pharmacy
Facility Name WALGREENS #11212
Street 2126 US HIGHWAY 79 S
City HENDERSON
State TX
ZIP 75654
Phone 903 655-7561
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/5/2025
Certificate Expiration Date 3/4/2027
Facility Type Pharmacy
Lab Director RAFAEL DEVRAE VEASY

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