47D2287494 CLIA NUMBER - WALGREENS 18265

Laboratory Demographics

  • CLIA Code: 47D2287494
  • Facility Name: WALGREENS 18265
  • Facility Address: 1 UNION ST
    BRANDON, VT
    ZIP 05733
  • Facility Phone: 802 247-8050
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MALLORY A. KETCHAM
  • NPI Number: 1861915464
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 47D2287494
LAB Type Pharmacy
Facility Name WALGREENS 18265
Street 1 UNION ST
City BRANDON
State VT
ZIP 05733
Phone 802 247-8050
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/15/2023
Certificate Expiration Date 8/14/2025
Facility Type Pharmacy
Lab Director MALLORY A. KETCHAM

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This page was last updated on: 3/20/2025