11D2034246 CLIA NUMBER - WALGREENS#6699

Laboratory Demographics

  • CLIA Code: 11D2034246
  • Facility Name: WALGREENS#6699
  • Facility Address: 1090 PEACHTREE INDUSTRIAL BLVD
    SUWANEE, GA
    ZIP 30024
  • Facility Phone: 678 546-0893
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MANSURAL K. CHOUDHURY
  • NPI Number: 1396750592
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2034246
LAB Type Pharmacy
Facility Name WALGREENS#6699
Street 1090 PEACHTREE INDUSTRIAL BLVD
City SUWANEE
State GA
ZIP 30024
Phone 678 546-0893
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/12/2025
Certificate Expiration Date 5/11/2027
Facility Type Pharmacy
Lab Director MANSURAL K. CHOUDHURY

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