11D2034335 CLIA NUMBER - WALGREENS #11490

Laboratory Demographics

  • CLIA Code: 11D2034335
  • Facility Name: WALGREENS #11490
  • Facility Address: 634 N CHURCH STREET
    THOMASTON, GA
    ZIP 30286
  • Facility Phone: 706 647-4000
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAWANDA L. WEST
  • NPI Number: 1538356399
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2034335
LAB Type Pharmacy
Facility Name WALGREENS #11490
Street 634 N CHURCH STREET
City THOMASTON
State GA
ZIP 30286
Phone 706 647-4000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/5/2025
Certificate Expiration Date 4/4/2027
Facility Type Pharmacy
Lab Director JAWANDA L. WEST

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