11D2031590 CLIA NUMBER - WALGREENS #10833

Laboratory Demographics

  • CLIA Code: 11D2031590
  • Facility Name: WALGREENS #10833
  • Facility Address: 615 LOVE AVENUE
    TIFTON, GA
    ZIP 31794
  • Facility Phone: 229 382-5359
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WILLIS V. HOLLAND
  • NPI Number: 1205016771
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2031590
LAB Type Pharmacy
Facility Name WALGREENS #10833
Street 615 LOVE AVENUE
City TIFTON
State GA
ZIP 31794
Phone 229 382-5359
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/21/2025
Certificate Expiration Date 4/20/2027
Facility Type Pharmacy
Lab Director WILLIS V. HOLLAND

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