50D2013673 CLIA NUMBER - WALGREENS #03518

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Laboratory Demographics

CLIA Number: 50D2013673

Facility Name: WALGREENS #03518

Facility Address:
25605 104TH AVE SE
KENT, WA
ZIP 98030
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Facility Phone Number: 253 813-6968

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1285649244

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	50D2013673
LAB Type	Pharmacy
Facility Name	WALGREENS #03518
Street	25605 104TH AVE SE
City	KENT
State	WA
ZIP	98030
Phone	253 813-6968
CertificateType	4
CertificateEffectiveDate	12/16/2020
CertificateExpirationDate	4/4/2028
FacilityType	Waiver

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