11D2191632 CLIA NUMBER - WALGREENS #11685

Laboratory Demographics

  • CLIA Code: 11D2191632
  • Facility Name: WALGREENS #11685
  • Facility Address: 201 PACIFIC AVENUE
    BREMEN, GA
    ZIP 30110
  • Facility Phone: 404 556-6536
  • Facility Type: Other - COVID 19 TEST SITE
  • Facility Type: Waiver
  • Lab Director: DR. SIMY T. CASASOLA
  • NPI Number: 1184863532
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2191632
LAB Type Other - COVID 19 TEST SITE
Facility Name WALGREENS #11685
Street 201 PACIFIC AVENUE
City BREMEN
State GA
ZIP 30110
Phone 404 556-6536
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/31/2024
Certificate Expiration Date 8/30/2026
Facility Type Other - COVID 19 TEST SITE
Lab Director DR. SIMY T. CASASOLA

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This page was last updated on: 3/20/2025