45D2231022 CLIA NUMBER - WALGREENS #04679

Laboratory Demographics

  • CLIA Code: 45D2231022
  • Facility Name: WALGREENS #04679
  • Facility Address: 2879 MONTANA AVE
    EL PASO, TX
    ZIP 79903
  • Facility Phone: 915 566-4464
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CONTESSA M. JARAMILLO
  • NPI Number: 1376558387
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2231022
LAB Type Pharmacy
Facility Name WALGREENS #04679
Street 2879 MONTANA AVE
City EL PASO
State TX
ZIP 79903
Phone 915 566-4464
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/29/2025
Certificate Expiration Date 7/28/2027
Facility Type Pharmacy
Lab Director CONTESSA M. JARAMILLO

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