11D2214268 CLIA NUMBER - WALGREENS #17028

Laboratory Demographics

  • CLIA Code: 11D2214268
  • Facility Name: WALGREENS #17028
  • Facility Address: 2125 HIGHWAY 155 NORTH
    MCDONOUGH, GA
    ZIP 30252
  • Facility Phone: 678 583-5592
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MIA MASHBURN
  • NPI Number: 1447774781
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2214268
LAB Type Pharmacy
Facility Name WALGREENS #17028
Street 2125 HIGHWAY 155 NORTH
City MCDONOUGH
State GA
ZIP 30252
Phone 678 583-5592
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 MIA MASHBURN

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