11D2050226 CLIA NUMBER - WALGREEN 10602

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Laboratory Demographics

CLIA Number: 11D2050226

Facility Name: WALGREEN 10602

Facility Address:
4310 WASHINGTON ROAD
EVANS, GA
ZIP 30809
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Facility Phone Number: 706 860-4179

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1790925691

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	11D2050226
LAB Type	Pharmacy
Facility Name	WALGREEN 10602
Street	4310 WASHINGTON ROAD
City	EVANS
State	GA
ZIP	30809
Phone	706 860-4179
CertificateType	4
CertificateEffectiveDate	8/11/2023
CertificateExpirationDate	8/10/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024