45D2077375 CLIA NUMBER - WALGREENS #04085

Laboratory Demographics

  • CLIA Code: 45D2077375
  • Facility Name: WALGREENS #04085
  • Facility Address: 4403 COLLEYVILLE BLVD
    COLLEYVILLE, TX
    ZIP 76034
  • Facility Phone: 817 514-9458
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JUSTIN J. THOMAS
  • NPI Number: 1497762413
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2077375
LAB Type Pharmacy
Facility Name WALGREENS #04085
Street 4403 COLLEYVILLE BLVD
City COLLEYVILLE
State TX
ZIP 76034
Phone 817 514-9458
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/23/2025
Certificate Expiration Date 2/22/2027
Facility Type Pharmacy
Lab Director JUSTIN J. THOMAS

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