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50D2084184 CLIA NUMBER - WALGREENS #15203

Laboratory Demographics

CLIA Number: 50D2084184

Facility Name: WALGREENS #15203

Facility Address:
26705 MAPLE VALLEY BLACK DIAMOND RD SE
MAPLE VALLEY, WA
ZIP 98038
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Facility Phone Number: 425 578-9410

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1801206057

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 50D2084184
LAB Type Pharmacy
Facility Name WALGREENS #15203
Street 26705 MAPLE VALLEY BLACK DIAMOND RD SE
City MAPLE VALLEY
State WA
ZIP 98038
Phone 425 578-9410
CertificateType 4
CertificateEffectiveDate 12/18/2020
CertificateExpirationDate 4/4/2028
FacilityType Waiver

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