11D2034365 CLIA NUMBER - WALGREENS #12621

Laboratory Demographics

  • CLIA Code: 11D2034365
  • Facility Name: WALGREENS #12621
  • Facility Address: 12955 BROWN BRIDGE ROAD
    COVINGTON, GA
    ZIP 30016
  • Facility Phone: 770 385-3226
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MS. JAQUADA K. FAVORS
  • NPI Number: 1720229511
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2034365
LAB Type Pharmacy
Facility Name WALGREENS #12621
Street 12955 BROWN BRIDGE ROAD
City COVINGTON
State GA
ZIP 30016
Phone 770 385-3226
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/4/2025
Certificate Expiration Date 6/3/2027
Facility Type Pharmacy
Lab Director MS. JAQUADA K. FAVORS

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