53D2231635 CLIA NUMBER - WALGREENS #09547

Laboratory Demographics

  • CLIA Code: 53D2231635
  • Facility Name: WALGREENS #09547
  • Facility Address: 1766 COFFEEN AVE
    SHERIDAN, WY
    ZIP 82801
  • Facility Phone: (307) 674-1936
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MATTHEW MONDRALA
  • NPI Number: 1407861594
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 53D2231635
LAB Type Pharmacy
Facility Name WALGREENS #09547
Street 1766 COFFEEN AVE
City SHERIDAN
State WY
ZIP 82801
Phone 3076741936
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/4/2025
Certificate Expiration Date 8/3/2027
Facility Type Pharmacy
Lab Director MATTHEW MONDRALA

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This page was last updated on: 5/18/2026