11D2034334 CLIA NUMBER - WALGREENS #11758

Laboratory Demographics

  • CLIA Code: 11D2034334
  • Facility Name: WALGREENS #11758
  • Facility Address: 6665 HIGHWAY 85
    RIVERDALE, GA
    ZIP 30274
  • Facility Phone: 770 907-6934
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALABA A. OGUNBADENIYI
  • NPI Number: 1649417171
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2034334
LAB Type Pharmacy
Facility Name WALGREENS #11758
Street 6665 HIGHWAY 85
City RIVERDALE
State GA
ZIP 30274
Phone 770 907-6934
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/22/2025
Certificate Expiration Date 2/21/2027
Facility Type Pharmacy
Lab Director ALABA A. OGUNBADENIYI

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