45D2217553 CLIA NUMBER - WALGREENS #12494

Laboratory Demographics

  • CLIA Code: 45D2217553
  • Facility Name: WALGREENS #12494
  • Facility Address: 1302 N VIRGINIA STREET
    PORT LAVACA, TX
    ZIP 77979
  • Facility Phone: 361 552-7451
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ROGERS K. TLYAJL
  • NPI Number: 1396971933
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2217553
LAB Type Pharmacy
Facility Name WALGREENS #12494
Street 1302 N VIRGINIA STREET
City PORT LAVACA
State TX
ZIP 77979
Phone 361 552-7451
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2025
Certificate Expiration Date 3/21/2027
Facility Type Pharmacy
Lab Director ROGERS K. TLYAJL

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