50D2061251 CLIA NUMBER - WALGREENS #4760

Laboratory Demographics

  • CLIA Code: 50D2061251
  • Facility Name: WALGREENS #4760
  • Facility Address: 12105 PACIFIC AVE S
    TACOMA, WA
    ZIP 98444
  • Facility Phone: 253 535-9302
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: THIENAN N. PHAM
  • NPI Number: 1497762371
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D2061251
LAB Type Pharmacy
Facility Name WALGREENS #4760
Street 12105 PACIFIC AVE S
City TACOMA
State WA
ZIP 98444
Phone 253 535-9302
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 Pharmacy
Lab Director THIENAN N. PHAM

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