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11D2217458 CLIA NUMBER - WALGREENS #10831

Laboratory Demographics

CLIA Number: 11D2217458

Facility Name: WALGREENS #10831

Facility Address:
1410 EAST SHOTWELL STREET
BAINBRIDGE, GA
ZIP 39819
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Facility Phone Number: 229 246-1441

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1588859888

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name Field Value
CLIA Number 11D2217458
LAB Type Pharmacy
Facility Name WALGREENS #10831
Street 1410 EAST SHOTWELL STREET
City BAINBRIDGE
State GA
ZIP 39819
Phone 229 246-1441
CertificateType 4
CertificateEffectiveDate 3/22/2023
CertificateExpirationDate 3/21/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024