11D2034577 CLIA NUMBER - WALGREENS#10968

Laboratory Demographics

  • CLIA Code: 11D2034577
  • Facility Name: WALGREENS#10968
  • Facility Address: 5000 FLOYD ROAD, SW
    MABLETON, GA
    ZIP 30126
  • Facility Phone: 770 819-9420
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TEIRA L. RICHARDON
  • NPI Number: 1306046735
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2034577
LAB Type Pharmacy
Facility Name WALGREENS#10968
Street 5000 FLOYD ROAD, SW
City MABLETON
State GA
ZIP 30126
Phone 770 819-9420
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/3/2025
Certificate Expiration Date 3/2/2027
Facility Type Pharmacy
Lab Director TEIRA L. RICHARDON

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