45D2303783 CLIA NUMBER - WALGREENS 21540

Laboratory Demographics

  • CLIA Code: 45D2303783
  • Facility Name: WALGREENS 21540
  • Facility Address: 602 SOUTH JEFFERSON AVE, SUITE 100
    MOUNT PLEASANT, TX
    ZIP 75455
  • Facility Phone: 903 575-1610
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SHAWN DANELLE RAYBURN
  • NPI Number: 1982383402
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2303783
LAB Type Pharmacy
Facility Name WALGREENS 21540
Street 602 SOUTH JEFFERSON AVE, SUITE 100
City MOUNT PLEASANT
State TX
ZIP 75455
Phone 903 575-1610
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/1/2024
Certificate Expiration Date 4/30/2026
Facility Type Pharmacy
Lab Director SHAWN DANELLE RAYBURN

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