45D2084768 CLIA NUMBER - WALGREENS #16030

Laboratory Demographics

  • CLIA Code: 45D2084768
  • Facility Name: WALGREENS #16030
  • Facility Address: 1105 US HWY 181
    PORTLAND, TX
    ZIP 78374
  • Facility Phone: 361 229-7251
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KELVIN PARK
  • NPI Number: 1215336359
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2084768
LAB Type Pharmacy
Facility Name WALGREENS #16030
Street 1105 US HWY 181
City PORTLAND
State TX
ZIP 78374
Phone 361 229-7251
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/31/2025
Certificate Expiration Date 8/30/2027
Facility Type Pharmacy
Lab Director KELVIN PARK

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