11D2042197 CLIA NUMBER - WALGREENS #05902

Laboratory Demographics

  • CLIA Code: 11D2042197
  • Facility Name: WALGREENS #05902
  • Facility Address: 2670 COBB PARKWAY, SE
    SMYRNA, GA
    ZIP 30080
  • Facility Phone: 770 955-7453
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHAEL L. WINN
  • NPI Number: 1760497960
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2042197
LAB Type Pharmacy
Facility Name WALGREENS #05902
Street 2670 COBB PARKWAY, SE
City SMYRNA
State GA
ZIP 30080
Phone 770 955-7453
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/22/2025
Certificate Expiration Date 4/21/2027
Facility Type Pharmacy
Lab Director MICHAEL L. WINN

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