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11D2033062 CLIA NUMBER - WALGREENS #5580

Laboratory Demographics

CLIA Number: 11D2033062

Facility Name: WALGREENS #5580

Facility Address:
2035 CANDLER ROAD
DECATUR, GA
ZIP 30032
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Facility Phone Number: 404 284-9912

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1972886406

Taxonomy: 183500000X - Pharmacist
An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care.

CLIA Record

Field Name Field Value
CLIA Number 11D2033062
LAB Type Pharmacy
Facility Name WALGREENS #5580
Street 2035 CANDLER ROAD
City DECATUR
State GA
ZIP 30032
Phone 404 284-9912
CertificateType 4
CertificateEffectiveDate 4/16/2023
CertificateExpirationDate 4/15/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024