11D2034353 CLIA NUMBER - WALGREENS #06560

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Laboratory Demographics

CLIA Number: 11D2034353

Facility Name: WALGREENS #06560

Facility Address:
3888 VINEVILLE AVENUE
MACON, GA
ZIP 31204
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Facility Phone Number: 478 471-6744

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1215942420

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	11D2034353
LAB Type	Pharmacy
Facility Name	WALGREENS #06560
Street	3888 VINEVILLE AVENUE
City	MACON
State	GA
ZIP	31204
Phone	478 471-6744
CertificateType	4
CertificateEffectiveDate	10/21/2023
CertificateExpirationDate	10/20/2025
FacilityType	Waiver

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