11D2030137 CLIA NUMBER - WALGREENS #10121

Laboratory Demographics

  • CLIA Code: 11D2030137
  • Facility Name: WALGREENS #10121
  • Facility Address: 199 E CHURCH STREET
    JASPER, GA
    ZIP 30143
  • Facility Phone: 706 253-9237
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SANDI HARRIS
  • NPI Number: 1477623692
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2030137
LAB Type Pharmacy
Facility Name WALGREENS #10121
Street 199 E CHURCH STREET
City JASPER
State GA
ZIP 30143
Phone 706 253-9237
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/16/2025
Certificate Expiration Date 4/15/2027
Facility Type Pharmacy
Lab Director SANDI HARRIS

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