01D2221272 CLIA NUMBER - WALGREENS #11704

Laboratory Demographics

  • CLIA Code: 01D2221272
  • Facility Name: WALGREENS #11704
  • Facility Address: 5301 SUMMERVILLE ROAD
    PHENIX CITY, AL
    ZIP 36867
  • Facility Phone: 334 297-3061
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ERIC GOLDEN
  • NPI Number: 1457508509
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 01D2221272
LAB Type Pharmacy
Facility Name WALGREENS #11704
Street 5301 SUMMERVILLE ROAD
City PHENIX CITY
State AL
ZIP 36867
Phone 334 297-3061
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2025
Certificate Expiration Date 4/19/2027
Facility Type Pharmacy
Lab Director ERIC GOLDEN

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