45D2073000 CLIA NUMBER - WALGREENS 04315

Laboratory Demographics

  • CLIA Code: 45D2073000
  • Facility Name: WALGREENS 04315
  • Facility Address: 4130 LEGACY DR
    PLANO, TX
    ZIP 75024
  • Facility Phone: 972 491-5677
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: YAMEEN A. MANDANIA
  • NPI Number: 1306851373
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2073000
LAB Type Pharmacy
Facility Name WALGREENS 04315
Street 4130 LEGACY DR
City PLANO
State TX
ZIP 75024
Phone 972 491-5677
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/14/2025
Certificate Expiration Date 8/13/2027
Facility Type Pharmacy
Lab Director YAMEEN A. MANDANIA

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