11D2034161 CLIA NUMBER - WALGREENS 09452

Laboratory Demographics

  • CLIA Code: 11D2034161
  • Facility Name: WALGREENS 09452
  • Facility Address: 855 VETERANS MEMORIAL HIGHWAY, SE
    MABLETON, GA
    ZIP 30126
  • Facility Phone: 770 819-7869
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WHITNEY SCOTT
  • NPI Number: 1770598880
  • Taxonomy: 333600000X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/16/2025
Certificate Expiration Date 8/15/2027
Facility Type Pharmacy
Lab Director WHITNEY SCOTT

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