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11D2034161 CLIA NUMBER - WALGREENS 09452

Laboratory Demographics

CLIA Number: 11D2034161

Facility Name: WALGREENS 09452

Facility Address:
855 VETERANS MEMORIAL HIGHWAY, SE
MABLETON, GA
ZIP 30126
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Facility Phone Number: 770 819-7869

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1770598880

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name Field Value
CLIA Number 11D2034161
LAB Type Pharmacy
Facility Name WALGREENS 09452
Street 855 VETERANS MEMORIAL HIGHWAY, SE
City MABLETON
State GA
ZIP 30126
Phone 770 819-7869
CertificateType 4
CertificateEffectiveDate 8/16/2023
CertificateExpirationDate 8/15/2025
FacilityType Waiver

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