11D2042713 CLIA NUMBER - WALGREENS #11995

Laboratory Demographics

  • CLIA Code: 11D2042713
  • Facility Name: WALGREENS #11995
  • Facility Address: 668 MAIN STREET
    THOMSON, GA
    ZIP 30824
  • Facility Phone: 706 595-1667
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MOHAMMEDRAZAVI MOMIN
  • NPI Number: 1386804896
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2042713
LAB Type Pharmacy
Facility Name WALGREENS #11995
Street 668 MAIN STREET
City THOMSON
State GA
ZIP 30824
Phone 706 595-1667
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2025
Certificate Expiration Date 3/21/2027
Facility Type Pharmacy
Lab Director MOHAMMEDRAZAVI MOMIN

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