45D2073536 CLIA NUMBER - WALGREENS #4787

Laboratory Demographics

  • CLIA Code: 45D2073536
  • Facility Name: WALGREENS #4787
  • Facility Address: 1226 W MCDERMOT DR
    ALLEN, TX
    ZIP 75013
  • Facility Phone: 972 396-0753
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PHAEDRA M. JORDAN
  • NPI Number: 1760497739
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2073536
LAB Type Pharmacy
Facility Name WALGREENS #4787
Street 1226 W MCDERMOT DR
City ALLEN
State TX
ZIP 75013
Phone 972 396-0753
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/20/2025
Certificate Expiration Date 9/19/2027
Facility Type Pharmacy
Lab Director PHAEDRA M. JORDAN

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