11D2034353 CLIA NUMBER - WALGREENS #06560

Laboratory Demographics

  • CLIA Code: 11D2034353
  • Facility Name: WALGREENS #06560
  • Facility Address: 3888 VINEVILLE AVENUE
    MACON, GA
    ZIP 31204
  • Facility Phone: 478 471-6744
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: EKTA R. PATEL
  • NPI Number: 1215942420
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2034353
LAB Type Pharmacy
Facility Name WALGREENS #06560
Street 3888 VINEVILLE AVENUE
City MACON
State GA
ZIP 31204
Phone 478 471-6744
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/21/2025
Certificate Expiration Date 10/20/2027
Facility Type Pharmacy
Lab Director EKTA R. PATEL

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