50D2043125 CLIA NUMBER - WALGREENS #10788

Laboratory Demographics

  • CLIA Code: 50D2043125
  • Facility Name: WALGREENS #10788
  • Facility Address: 1502 N LIBERTY LAKE RD
    LIBERTY LAKE, WA
    ZIP 99019
  • Facility Phone: 509 570-0485
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: FRED CAZEAU
  • NPI Number: 1376718759
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D2043125
LAB Type Pharmacy
Facility Name WALGREENS #10788
Street 1502 N LIBERTY LAKE RD
City LIBERTY LAKE
State WA
ZIP 99019
Phone 509 570-0485
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/18/2020
Certificate Expiration Date 4/4/2028
Facility Type Pharmacy
Lab Director FRED CAZEAU

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