11D2034179 CLIA NUMBER - WALGREEN #07478

Laboratory Demographics

  • CLIA Code: 11D2034179
  • Facility Name: WALGREEN #07478
  • Facility Address: 2781 LAVISTA ROAD
    DECATUR, GA
    ZIP 30033
  • Facility Phone: 404 929-1013
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMANDA J. SRUBAS
  • NPI Number: 1013922210
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2034179
LAB Type Pharmacy
Facility Name WALGREEN #07478
Street 2781 LAVISTA ROAD
City DECATUR
State GA
ZIP 30033
Phone 404 929-1013
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/22/2025
Certificate Expiration Date 2/21/2027
Facility Type Pharmacy
Lab Director AMANDA J. SRUBAS

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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