11D1078759 CLIA NUMBER - DUNWOODY PHARMACY

Laboratory Demographics

  • CLIA Code: 11D1078759
  • Facility Name: DUNWOODY PHARMACY
  • Facility Address: 4675 N SHALLOWFORD ROAD SUITE 101
    DUNWOODY, GA
    ZIP 30338
  • Facility Phone: 770 455-1144
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHARLES R. WILSON
  • NPI Number: 1568473064
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D1078759
LAB Type Pharmacy
Facility Name DUNWOODY PHARMACY
Street 4675 N SHALLOWFORD ROAD SUITE 101
City DUNWOODY
State GA
ZIP 30338
Phone 770 455-1144
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/16/2024
Certificate Expiration Date 1/15/2026
Facility Type Pharmacy
Lab Director CHARLES R. WILSON

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