50D2013496 CLIA NUMBER - WALGREENS #06103

Laboratory Demographics

  • CLIA Code: 50D2013496
  • Facility Name: WALGREENS #06103
  • Facility Address: 1905 SE 164TH AVE
    VANCOUVER, WA
    ZIP 98683
  • Facility Phone: 360 885-2983
  • Facility Type: Health Fair
  • Facility Type: Waiver
  • Lab Director: BRANDON L. CHRISOPULOS
  • NPI Number: 1912912981
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D2013496
LAB Type Health Fair
Facility Name WALGREENS #06103
Street 1905 SE 164TH AVE
City VANCOUVER
State WA
ZIP 98683
Phone 360 885-2983
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/17/2020
Certificate Expiration Date 4/4/2028
Facility Type Health Fair
Lab Director BRANDON L. CHRISOPULOS

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