50D2061029 CLIA NUMBER - WALGREENS #11635

Laboratory Demographics

  • CLIA Code: 50D2061029
  • Facility Name: WALGREENS #11635
  • Facility Address: 6708 NE 63RD ST
    VANCOUVER, WA
    ZIP 98661
  • Facility Phone: 360 696-0759
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MAYA M. MOURAD
  • NPI Number: 1649285636
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D2061029
LAB Type Pharmacy
Facility Name WALGREENS #11635
Street 6708 NE 63RD ST
City VANCOUVER
State WA
ZIP 98661
Phone 360 696-0759
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 MAYA M. MOURAD

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