45D2269899 CLIA NUMBER - WALGREENS #21564

Laboratory Demographics

  • CLIA Code: 45D2269899
  • Facility Name: WALGREENS #21564
  • Facility Address: 621 SOUTH JACKSON STREET SUITE B
    JACKSONVILLE, TX
    ZIP 75766
  • Facility Phone: 903 339-2169
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ARIEL CORDOVA
  • NPI Number: 1780363325
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2269899
LAB Type Pharmacy
Facility Name WALGREENS #21564
Street 621 SOUTH JACKSON STREET SUITE B
City JACKSONVILLE
State TX
ZIP 75766
Phone 903 339-2169
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/5/2024
Certificate Expiration Date 10/4/2026
Facility Type Pharmacy
Lab Director ARIEL CORDOVA

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