11D2042193 CLIA NUMBER - WALGREENS #06461

Laboratory Demographics

  • CLIA Code: 11D2042193
  • Facility Name: WALGREENS #06461
  • Facility Address: 1762 MARS HILL ROAD, NW
    ACWORTH, GA
    ZIP 30101
  • Facility Phone: 770 424-2177
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PURA D. SANTIAGO
  • NPI Number: 1508380080
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2042193
LAB Type Pharmacy
Facility Name WALGREENS #06461
Street 1762 MARS HILL ROAD, NW
City ACWORTH
State GA
ZIP 30101
Phone 770 424-2177
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/17/2025
Certificate Expiration Date 6/16/2027
Facility Type Pharmacy
Lab Director PURA D. SANTIAGO

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This page was last updated on: 6/4/2025