11D2034604 CLIA NUMBER - WALGREENS #11792

Laboratory Demographics

  • CLIA Code: 11D2034604
  • Facility Name: WALGREENS #11792
  • Facility Address: 102 S 1ST STREET
    JESUP, GA
    ZIP 31545
  • Facility Phone: 912 588-1035
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MISTY MOORE
  • NPI Number: 1982858718
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2034604
LAB Type Pharmacy
Facility Name WALGREENS #11792
Street 102 S 1ST STREET
City JESUP
State GA
ZIP 31545
Phone 912 588-1035
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/7/2025
Certificate Expiration Date 4/6/2027
Facility Type Pharmacy
Lab Director MISTY MOORE

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