45D2154881 CLIA NUMBER - WALGREENS #21491

Laboratory Demographics

  • CLIA Code: 45D2154881
  • Facility Name: WALGREENS #21491
  • Facility Address: 100 RICE ROAD
    TYLER, TX
    ZIP 75703
  • Facility Phone: 903 561-7943
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JENNIFER KONIECZNY
  • NPI Number: 1003989575
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2154881
LAB Type Pharmacy
Facility Name WALGREENS #21491
Street 100 RICE ROAD
City TYLER
State TX
ZIP 75703
Phone 903 561-7943
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/20/2024
Certificate Expiration Date 9/19/2026
Facility Type Pharmacy
Lab Director JENNIFER KONIECZNY

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