11D2036500 CLIA NUMBER - WALGREENS 06371

Laboratory Demographics

  • CLIA Code: 11D2036500
  • Facility Name: WALGREENS 06371
  • Facility Address: 880 HIGHWAY 85 S
    FAYETTEVILLE, GA
    ZIP 30214
  • Facility Phone: 678 817-4787
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KIM T. MACH
  • NPI Number: 1902321508
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2036500
LAB Type Pharmacy
Facility Name WALGREENS 06371
Street 880 HIGHWAY 85 S
City FAYETTEVILLE
State GA
ZIP 30214
Phone 678 817-4787
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/10/2025
Certificate Expiration Date 8/9/2027
Facility Type Pharmacy
Lab Director KIM T. MACH

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