11D2047813 CLIA NUMBER - WALGREENS #11686

Laboratory Demographics

  • CLIA Code: 11D2047813
  • Facility Name: WALGREENS #11686
  • Facility Address: 303 CHARLIE WATTS DRIVE
    DALLAS, GA
    ZIP 30157
  • Facility Phone: 770 443-4886
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: IKENNA ANYANWU
  • NPI Number: 1053835553
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2047813
LAB Type Pharmacy
Facility Name WALGREENS #11686
Street 303 CHARLIE WATTS DRIVE
City DALLAS
State GA
ZIP 30157
Phone 770 443-4886
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/5/2025
Certificate Expiration Date 4/4/2027
Facility Type Pharmacy
Lab Director IKENNA ANYANWU

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