11D2028571 CLIA NUMBER - WALGREENS #9629

Laboratory Demographics

  • CLIA Code: 11D2028571
  • Facility Name: WALGREENS #9629
  • Facility Address: 4398 ATLANTA HIGHWAY
    LOGANVILLE, GA
    ZIP 30052
  • Facility Phone: 678 639-0213
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: OLADIPO A. ADEBISI
  • NPI Number: 1245255546
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2028571
LAB Type Pharmacy
Facility Name WALGREENS #9629
Street 4398 ATLANTA HIGHWAY
City LOGANVILLE
State GA
ZIP 30052
Phone 678 639-0213
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2025
Certificate Expiration Date 3/21/2027
Facility Type Pharmacy
Lab Director OLADIPO A. ADEBISI

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