11D2034579 CLIA NUMBER - WALGREENS #02455

Laboratory Demographics

  • CLIA Code: 11D2034579
  • Facility Name: WALGREENS #02455
  • Facility Address: 2580 SANDY PLAINS ROAD
    MARIETTA, GA
    ZIP 30066
  • Facility Phone: 770 565-5681
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KIMBERLY A. OBELDOBEL
  • NPI Number: 1699782672
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2034579
LAB Type Pharmacy
Facility Name WALGREENS #02455
Street 2580 SANDY PLAINS ROAD
City MARIETTA
State GA
ZIP 30066
Phone 770 565-5681
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/8/2025
Certificate Expiration Date 6/7/2027
Facility Type Pharmacy
Lab Director KIMBERLY A. OBELDOBEL

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