49D2290581 CLIA NUMBER - WALGREENS 19365

Laboratory Demographics

  • CLIA Code: 49D2290581
  • Facility Name: WALGREENS 19365
  • Facility Address: 1840 TAPPAHANNOCK BLVD
    TAPPAHANNOCK, VA
    ZIP 22560
  • Facility Phone: 804 443-4709
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: IRENE A. BRAKO
  • NPI Number: 1417470220
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D2290581
LAB Type Pharmacy
Facility Name WALGREENS 19365
Street 1840 TAPPAHANNOCK BLVD
City TAPPAHANNOCK
State VA
ZIP 22560
Phone 804 443-4709
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/27/2025
Certificate Expiration Date 9/26/2027
Facility Type Pharmacy
Lab Director IRENE A. BRAKO

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