11D2034219 CLIA NUMBER - WALGREEN#12147

Laboratory Demographics

  • CLIA Code: 11D2034219
  • Facility Name: WALGREEN#12147
  • Facility Address: 575 DACULA ROAD
    DACULA, GA
    ZIP 30019
  • Facility Phone: 770 547-6508
  • Facility Type: Other - COVID TESTING SITE
  • Facility Type: Waiver
  • Lab Director: CHANTHAKHONE JUAREZ
  • NPI Number: 1437314556
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2034219
LAB Type Other - COVID TESTING SITE
Facility Name WALGREEN#12147
Street 575 DACULA ROAD
City DACULA
State GA
ZIP 30019
Phone 770 547-6508
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/27/2024
Certificate Expiration Date 10/26/2026
Facility Type Other - COVID TESTING SITE
Lab Director CHANTHAKHONE JUAREZ

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