11D2034342 CLIA NUMBER - WALGREEN #9630

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Laboratory Demographics

CLIA Number: 11D2034342

Facility Name: WALGREEN #9630

Facility Address:
4617 JONESBORO ROAD
UNION CITY, GA
ZIP 30291
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Facility Phone Number: 770 969-7458

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1306851415

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

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
CertificateType	4
CertificateEffectiveDate	7/29/2023
CertificateExpirationDate	7/28/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024