11D2034342 CLIA NUMBER - WALGREEN #9630

Laboratory Demographics

  • CLIA Code: 11D2034342
  • Facility Name: WALGREEN #9630
  • Facility Address: 4617 JONESBORO ROAD
    UNION CITY, GA
    ZIP 30291
  • Facility Phone: 770 969-7458
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JARVIS A. PERRY
  • NPI Number: 1306851415
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2034342
LAB Type Pharmacy
Facility Name WALGREEN #9630
Street 4617 JONESBORO ROAD
City UNION CITY
State GA
ZIP 30291
Phone 770 969-7458
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/29/2025
Certificate Expiration Date 7/28/2027
Facility Type Pharmacy
Lab Director JARVIS A. PERRY

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