11D2034332 CLIA NUMBER - WALGREENS 09622

Laboratory Demographics

  • CLIA Code: 11D2034332
  • Facility Name: WALGREENS 09622
  • Facility Address: 115 VERNON STREET
    LAGRANGE, GA
    ZIP 30240
  • Facility Phone: 706 812-9852
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GREGORY C. OFFOR
  • NPI Number: 1427003755
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2034332
LAB Type Pharmacy
Facility Name WALGREENS 09622
Street 115 VERNON STREET
City LAGRANGE
State GA
ZIP 30240
Phone 706 812-9852
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/16/2025
Certificate Expiration Date 8/15/2027
Facility Type Pharmacy
Lab Director GREGORY C. OFFOR

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