45D2309541 CLIA NUMBER - WALGREENS 21521

Laboratory Demographics

  • CLIA Code: 45D2309541
  • Facility Name: WALGREENS 21521
  • Facility Address: 5118 EAST INTERSTATE 20 SERVICE ROAD SOUTH
    WILLOW PARK, TX
    ZIP 76008
  • Facility Phone: 817 441-5983
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MIN YOUNG SUNG
  • NPI Number: 1679250930
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2309541
LAB Type Pharmacy
Facility Name WALGREENS 21521
Street 5118 EAST INTERSTATE 20 SERVICE ROAD SOUTH
City WILLOW PARK
State TX
ZIP 76008
Phone 817 441-5983
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/16/2024
Certificate Expiration Date 8/15/2026
Facility Type Pharmacy
Lab Director MIN YOUNG SUNG

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