11D2028701 CLIA NUMBER - WALGREENS #06372

Laboratory Demographics

  • CLIA Code: 11D2028701
  • Facility Name: WALGREENS #06372
  • Facility Address: 780 GLYNN STREET, N
    FAYETTEVILLE, GA
    ZIP 30214
  • Facility Phone: 770 716-2262
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAYLYN J. DAVIS
  • NPI Number: 1942215157
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2028701
LAB Type Pharmacy
Facility Name WALGREENS #06372
Street 780 GLYNN STREET, N
City FAYETTEVILLE
State GA
ZIP 30214
Phone 770 716-2262
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/14/2025
Certificate Expiration Date 7/13/2027
Facility Type Pharmacy
Lab Director JAYLYN J. DAVIS

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