11D2034398 CLIA NUMBER - WALGREENS #13759

Laboratory Demographics

  • CLIA Code: 11D2034398
  • Facility Name: WALGREENS #13759
  • Facility Address: 6120 OLD NATIONAL HIGHWAY
    COLLEGE PARK, GA
    ZIP 30349
  • Facility Phone: 678 536-4050
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LATISIA E. BROOKS
  • NPI Number: 1205140118
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2034398
LAB Type Pharmacy
Facility Name WALGREENS #13759
Street 6120 OLD NATIONAL HIGHWAY
City COLLEGE PARK
State GA
ZIP 30349
Phone 678 536-4050
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/30/2025
Certificate Expiration Date 4/29/2027
Facility Type Pharmacy
Lab Director LATISIA E. BROOKS

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