45D2072694 CLIA NUMBER - WALGREENS #09720

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Laboratory Demographics

CLIA Number: 45D2072694

Facility Name: WALGREENS #09720

Facility Address:
4103 S GREAT SOUTHWEST PKWY
GRAND PRAIRIE, TX
ZIP 75052
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Facility Phone Number: 972 602-8156

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1801803812

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	45D2072694
LAB Type	Pharmacy
Facility Name	WALGREENS #09720
Street	4103 S GREAT SOUTHWEST PKWY
City	GRAND PRAIRIE
State	TX
ZIP	75052
Phone	972 602-8156
CertificateType	4
CertificateEffectiveDate	2/19/2023
CertificateExpirationDate	2/18/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024