45D2077346 CLIA NUMBER - WALGREENS #05919

Laboratory Demographics

  • CLIA Code: 45D2077346
  • Facility Name: WALGREENS #05919
  • Facility Address: 1701 W SOUTHLAKE BLVD
    SOUTHLAKE, TX
    ZIP 76092
  • Facility Phone: 817 488-4978
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHA HARAM
  • NPI Number: 1114932100
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2077346
LAB Type Pharmacy
Facility Name WALGREENS #05919
Street 1701 W SOUTHLAKE BLVD
City SOUTHLAKE
State TX
ZIP 76092
Phone 817 488-4978
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/2/2025
Certificate Expiration Date 8/1/2027
Facility Type Pharmacy
Lab Director CHA HARAM

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