11D2042191 CLIA NUMBER - WALGREENS #05811

Laboratory Demographics

  • CLIA Code: 11D2042191
  • Facility Name: WALGREENS #05811
  • Facility Address: 4120 AUSTELL ROAD
    AUSTELL, GA
    ZIP 30106
  • Facility Phone: 770 941-2918
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GREGORY GUILLAUME
  • NPI Number: 1225043433
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2042191
LAB Type Pharmacy
Facility Name WALGREENS #05811
Street 4120 AUSTELL ROAD
City AUSTELL
State GA
ZIP 30106
Phone 770 941-2918
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/19/2025
Certificate Expiration Date 3/18/2027
Facility Type Pharmacy
Lab Director GREGORY GUILLAUME

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