11D2214247 CLIA NUMBER - WALGREENS #17077

Laboratory Demographics

  • CLIA Code: 11D2214247
  • Facility Name: WALGREENS #17077
  • Facility Address: 12075 HIGHWAY 92
    WOODSTOCK, GA
    ZIP 30188
  • Facility Phone: 770 926-4494
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KRISTI BOLLINGER
  • NPI Number: 1508389370
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2214247
LAB Type Pharmacy
Facility Name WALGREENS #17077
Street 12075 HIGHWAY 92
City WOODSTOCK
State GA
ZIP 30188
Phone 770 926-4494
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 KRISTI BOLLINGER

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