50D2036563 CLIA NUMBER - WALGREENS #12053

Laboratory Demographics

  • CLIA Code: 50D2036563
  • Facility Name: WALGREENS #12053
  • Facility Address: 6400 W NOB HILL BLVD
    YAKIMA, WA
    ZIP 98908
  • Facility Phone: 509 965-0541
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LEROI DE-SOUZA
  • NPI Number: 1003048505
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D2036563
LAB Type Pharmacy
Facility Name WALGREENS #12053
Street 6400 W NOB HILL BLVD
City YAKIMA
State WA
ZIP 98908
Phone 509 965-0541
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/8/2021
Certificate Expiration Date 4/4/2028
Facility Type Pharmacy
Lab Director LEROI DE-SOUZA

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This page was last updated on: 6/4/2025