11D2034215 CLIA NUMBER - WALGREENS #11793

Laboratory Demographics

  • CLIA Code: 11D2034215
  • Facility Name: WALGREENS #11793
  • Facility Address: 1100 BALL STREET
    PERRY, GA
    ZIP 31069
  • Facility Phone: 478 987-1222
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TSIM NUJ LY
  • NPI Number: 1063679363
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2034215
LAB Type Pharmacy
Facility Name WALGREENS #11793
Street 1100 BALL STREET
City PERRY
State GA
ZIP 31069
Phone 478 987-1222
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/29/2025
Certificate Expiration Date 3/28/2027
Facility Type Pharmacy
Lab Director TSIM NUJ LY

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