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49D2040001 CLIA NUMBER - WALGREENS #10712

Laboratory Demographics

CLIA Number: 49D2040001

Facility Name: WALGREENS #10712

Facility Address:
10320 MAIN STREET
FAIRFAX, VA
ZIP 22030
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Facility Phone Number: 703 591-1025

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1245447390

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name Field Value
CLIA Number 49D2040001
LAB Type Pharmacy
Facility Name WALGREENS #10712
Street 10320 MAIN STREET
City FAIRFAX
State VA
ZIP 22030
Phone 703 591-1025
CertificateType 4
CertificateEffectiveDate 4/20/2024
CertificateExpirationDate 4/19/2026
FacilityType Waiver

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This page was last updated on: 4/23/2024