11D2214266 CLIA NUMBER - WALGREENS #17033

Laboratory Demographics

  • CLIA Code: 11D2214266
  • Facility Name: WALGREENS #17033
  • Facility Address: 4692 RIDGE ROAD
    DOUGLASVILLE, GA
    ZIP 30134
  • Facility Phone: 770 489-8699
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOAN HAASE
  • NPI Number: 1649796384
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2214266
LAB Type Pharmacy
Facility Name WALGREENS #17033
Street 4692 RIDGE ROAD
City DOUGLASVILLE
State GA
ZIP 30134
Phone 770 489-8699
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 JOAN HAASE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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