11D2031588 CLIA NUMBER - WALGREENS #05903

Laboratory Demographics

  • CLIA Code: 11D2031588
  • Facility Name: WALGREENS #05903
  • Facility Address: 4395 KIMBALL BRIDGE ROAD
    ALPHARETTA, GA
    ZIP 30022
  • Facility Phone: 678 566-0422
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DAVID R. SHORE
  • NPI Number: 1205841400
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2031588
LAB Type Pharmacy
Facility Name WALGREENS #05903
Street 4395 KIMBALL BRIDGE ROAD
City ALPHARETTA
State GA
ZIP 30022
Phone 678 566-0422
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/29/2025
Certificate Expiration Date 3/28/2027
Facility Type Pharmacy
Lab Director DAVID R. SHORE

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