11D2214245 CLIA NUMBER - WALGREENS #19735

Laboratory Demographics

  • CLIA Code: 11D2214245
  • Facility Name: WALGREENS #19735
  • Facility Address: 3650 WHEELER ROAD
    AUGUSTA, GA
    ZIP 30909
  • Facility Phone: 706 210-7991
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WILLIAM PARK
  • NPI Number: 1841716586
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2214245
LAB Type Pharmacy
Facility Name WALGREENS #19735
Street 3650 WHEELER ROAD
City AUGUSTA
State GA
ZIP 30909
Phone 706 210-7991
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/22/2025
Certificate Expiration Date 2/21/2027
Facility Type Pharmacy
Lab Director WILLIAM PARK

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