11D2034598 CLIA NUMBER - WALGREENS #06481

Laboratory Demographics

  • CLIA Code: 11D2034598
  • Facility Name: WALGREENS #06481
  • Facility Address: 3584 WESLEY CHAPEL ROAD
    DECATUR, GA
    ZIP 30034
  • Facility Phone: 770 987-9093
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: EBENEZER M. ESSUMAN
  • NPI Number: 1497760607
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2034598
LAB Type Pharmacy
Facility Name WALGREENS #06481
Street 3584 WESLEY CHAPEL ROAD
City DECATUR
State GA
ZIP 30034
Phone 770 987-9093
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/12/2025
Certificate Expiration Date 10/11/2027
Facility Type Pharmacy
Lab Director EBENEZER M. ESSUMAN

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