11D2040516 CLIA NUMBER - WALGREENS #05446

Laboratory Demographics

  • CLIA Code: 11D2040516
  • Facility Name: WALGREENS #05446
  • Facility Address: 2990 FIVE FORKS TRICKUM ROAD
    LAWRENCEVILLE, GA
    ZIP 30044
  • Facility Phone: 770 978-6475
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HONG J. TO
  • NPI Number: 1679588875
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2040516
LAB Type Pharmacy
Facility Name WALGREENS #05446
Street 2990 FIVE FORKS TRICKUM ROAD
City LAWRENCEVILLE
State GA
ZIP 30044
Phone 770 978-6475
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/22/2025
Certificate Expiration Date 2/21/2027
Facility Type Pharmacy
Lab Director HONG J. TO

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