11D2034349 CLIA NUMBER - WALGREENS #12319

Laboratory Demographics

  • CLIA Code: 11D2034349
  • Facility Name: WALGREENS #12319
  • Facility Address: 126 BROAD STREET
    HAWKINSVILLE, GA
    ZIP 31036
  • Facility Phone: 478 783-4700
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GREGORY A. MARTIN
  • NPI Number: 1205071800
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2034349
LAB Type Pharmacy
Facility Name WALGREENS #12319
Street 126 BROAD STREET
City HAWKINSVILLE
State GA
ZIP 31036
Phone 478 783-4700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/13/2025
Certificate Expiration Date 10/12/2027
Facility Type Pharmacy
Lab Director GREGORY A. MARTIN

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