11D2034605 CLIA NUMBER - WALGREENS #11661

Laboratory Demographics

  • CLIA Code: 11D2034605
  • Facility Name: WALGREENS #11661
  • Facility Address: 602 PETERSON AVENUE, S
    DOUGLAS, GA
    ZIP 31533
  • Facility Phone: 912 260-1198
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMIE L. HUTCHENSON
  • NPI Number: 1245401967
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2034605
LAB Type Pharmacy
Facility Name WALGREENS #11661
Street 602 PETERSON AVENUE, S
City DOUGLAS
State GA
ZIP 31533
Phone 912 260-1198
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/14/2025
Certificate Expiration Date 7/13/2027
Facility Type Pharmacy
Lab Director AMIE L. HUTCHENSON

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