45D2072846 CLIA NUMBER - WALGREENS #11175

Laboratory Demographics

  • CLIA Code: 45D2072846
  • Facility Name: WALGREENS #11175
  • Facility Address: 701 US HIGHWAY 259 N
    KILGORE, TX
    ZIP 75662
  • Facility Phone: 903 983-2892
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AIMEE LUSSON
  • NPI Number: 1295925741
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2072846
LAB Type Pharmacy
Facility Name WALGREENS #11175
Street 701 US HIGHWAY 259 N
City KILGORE
State TX
ZIP 75662
Phone 903 983-2892
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/5/2025
Certificate Expiration Date 4/4/2027
Facility Type Pharmacy
Lab Director AIMEE LUSSON

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