11D2034616 CLIA NUMBER - WALGREENS #07608

Laboratory Demographics

  • CLIA Code: 11D2034616
  • Facility Name: WALGREENS #07608
  • Facility Address: 5435 FIVE FORKS TRICKUM ROAD, SW
    STONE MOUNTAIN, GA
    ZIP 30087
  • Facility Phone: 770 935-5607
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SONAL B. PATEL
  • NPI Number: 1962417071
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2034616
LAB Type Pharmacy
Facility Name WALGREENS #07608
Street 5435 FIVE FORKS TRICKUM ROAD, SW
City STONE MOUNTAIN
State GA
ZIP 30087
Phone 770 935-5607
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/18/2025
Certificate Expiration Date 7/17/2027
Facility Type Pharmacy
Lab Director SONAL B. PATEL

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