11D2034581 CLIA NUMBER - WALGREENS 05901

Laboratory Demographics

  • CLIA Code: 11D2034581
  • Facility Name: WALGREENS 05901
  • Facility Address: 2390 S COBB DRIVE, SE
    SMYRNA, GA
    ZIP 30080
  • Facility Phone: 678 556-0673
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: IJEOMA A. EZEGBO
  • NPI Number: 1982128468
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2034581
LAB Type Pharmacy
Facility Name WALGREENS 05901
Street 2390 S COBB DRIVE, SE
City SMYRNA
State GA
ZIP 30080
Phone 678 556-0673
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/11/2025
Certificate Expiration Date 8/10/2027
Facility Type Pharmacy
Lab Director IJEOMA A. EZEGBO

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