11D2037126 CLIA NUMBER - WALGREENS 11791

Laboratory Demographics

  • CLIA Code: 11D2037126
  • Facility Name: WALGREENS 11791
  • Facility Address: 2100 N BROAD STREET
    COMMERCE, GA
    ZIP 30529
  • Facility Phone: 706 336-5931
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MILDALY D. BLANCO
  • NPI Number: 1538305933
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2037126
LAB Type Pharmacy
Facility Name WALGREENS 11791
Street 2100 N BROAD STREET
City COMMERCE
State GA
ZIP 30529
Phone 706 336-5931
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/11/2025
Certificate Expiration Date 8/10/2027
Facility Type Pharmacy
Lab Director MILDALY D. BLANCO

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