49D2014569 CLIA NUMBER - WALGREENS #10416

Laboratory Demographics

  • CLIA Code: 49D2014569
  • Facility Name: WALGREENS #10416
  • Facility Address: 2902 GODWIN BOULEVARD
    SUFFOLK, VA
    ZIP 23434
  • Facility Phone: 757 539-0734
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KEVIN J. GOSIK
  • NPI Number: 1982894960
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D2014569
LAB Type Pharmacy
Facility Name WALGREENS #10416
Street 2902 GODWIN BOULEVARD
City SUFFOLK
State VA
ZIP 23434
Phone 757 539-0734
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/28/2025
Certificate Expiration Date 4/27/2027
Facility Type Pharmacy
Lab Director KEVIN J. GOSIK

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