45D2205947 CLIA NUMBER - WALGREENS #11645

Laboratory Demographics

  • CLIA Code: 45D2205947
  • Facility Name: WALGREENS #11645
  • Facility Address: 10152 LAKE JUNE RD
    DALLAS, TX
    ZIP 75217
  • Facility Phone: 972 370-9367
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JUSTIN COOPER
  • NPI Number: 1750396701
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2205947
LAB Type Pharmacy
Facility Name WALGREENS #11645
Street 10152 LAKE JUNE RD
City DALLAS
State TX
ZIP 75217
Phone 972 370-9367
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/16/2024
Certificate Expiration Date 12/15/2026
Facility Type Pharmacy
Lab Director JUSTIN COOPER

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