11D2034216 CLIA NUMBER - WALGREENS #07995

Laboratory Demographics

  • CLIA Code: 11D2034216
  • Facility Name: WALGREENS #07995
  • Facility Address: 4765 REDAN ROAD
    STONE MOUNTAIN, GA
    ZIP 30088
  • Facility Phone: 404 299-5322
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: FISEHA FETTENE
  • NPI Number: 1538290135
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2034216
LAB Type Pharmacy
Facility Name WALGREENS #07995
Street 4765 REDAN ROAD
City STONE MOUNTAIN
State GA
ZIP 30088
Phone 404 299-5322
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/30/2025
Certificate Expiration Date 7/29/2027
Facility Type Pharmacy
Lab Director FISEHA FETTENE

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