11D2042705 CLIA NUMBER - WALGREENS 09257

Laboratory Demographics

  • CLIA Code: 11D2042705
  • Facility Name: WALGREENS 09257
  • Facility Address: 613 NORTHSIDE DRIVE, E
    STATESBORO, GA
    ZIP 30458
  • Facility Phone: 912 489-3008
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KELLEY F. COLLINS
  • NPI Number: 1861916272
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2042705
LAB Type Pharmacy
Facility Name WALGREENS 09257
Street 613 NORTHSIDE DRIVE, E
City STATESBORO
State GA
ZIP 30458
Phone 912 489-3008
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/17/2025
Certificate Expiration Date 10/16/2027
Facility Type Pharmacy
Lab Director KELLEY F. COLLINS

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