11D2034582 CLIA NUMBER - WALGREENS#11491

Laboratory Demographics

  • CLIA Code: 11D2034582
  • Facility Name: WALGREENS#11491
  • Facility Address: 684 W BANKHEAD HIGHWAY
    VILLA RICA, GA
    ZIP 30180
  • Facility Phone: 770 459-9344
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GAYNELLE GEORGE
  • NPI Number: 1487826228
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2034582
LAB Type Pharmacy
Facility Name WALGREENS#11491
Street 684 W BANKHEAD HIGHWAY
City VILLA RICA
State GA
ZIP 30180
Phone 770 459-9344
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2025
Certificate Expiration Date 4/19/2027
Facility Type Pharmacy
Lab Director GAYNELLE GEORGE

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