11D2034615 CLIA NUMBER - WALGREENS #6138

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Laboratory Demographics

CLIA Number: 11D2034615

Facility Name: WALGREENS #6138

Facility Address:
2065 S HAIRSTON ROAD
DECATUR, GA
ZIP 30035
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Facility Phone Number: 770 322-1290

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1104831312

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	11D2034615
LAB Type	Pharmacy
Facility Name	WALGREENS #6138
Street	2065 S HAIRSTON ROAD
City	DECATUR
State	GA
ZIP	30035
Phone	770 322-1290
CertificateType	4
CertificateEffectiveDate	7/20/2023
CertificateExpirationDate	7/19/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024