45D2307527 CLIA NUMBER - WALGREENS #21566

Laboratory Demographics

  • CLIA Code: 45D2307527
  • Facility Name: WALGREENS #21566
  • Facility Address: 5100 EAST I-30
    FATE, TX
    ZIP 75189
  • Facility Phone: 469 530-6154
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRANDA TRUONG
  • NPI Number: 1477239093
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2307527
LAB Type Pharmacy
Facility Name WALGREENS #21566
Street 5100 EAST I-30
City FATE
State TX
ZIP 75189
Phone 469 530-6154
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/10/2024
Certificate Expiration Date 7/9/2026
Facility Type Pharmacy
Lab Director BRANDA TRUONG

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