49D2062078 CLIA NUMBER - WALGREENS # 15669

Laboratory Demographics

  • CLIA Code: 49D2062078
  • Facility Name: WALGREENS # 15669
  • Facility Address: 119 E JACKSON STREET
    GATE CITY, VA
    ZIP 24251
  • Facility Phone: 276 386-3821
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TYLER H. HALSTEAD
  • NPI Number: 1619214277
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D2062078
LAB Type Pharmacy
Facility Name WALGREENS # 15669
Street 119 E JACKSON STREET
City GATE CITY
State VA
ZIP 24251
Phone 276 386-3821
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/3/2025
Certificate Expiration Date 2/2/2027
Facility Type Pharmacy
Lab Director TYLER H. HALSTEAD

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