11D2217464 CLIA NUMBER - WALGREENS #12553

Laboratory Demographics

  • CLIA Code: 11D2217464
  • Facility Name: WALGREENS #12553
  • Facility Address: 266 EAST BROAD STREET
    CAMILLA, GA
    ZIP 31730
  • Facility Phone: 229 336-2976
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MACKEY STACI
  • NPI Number: 1528200235
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2217464
LAB Type Pharmacy
Facility Name WALGREENS #12553
Street 266 EAST BROAD STREET
City CAMILLA
State GA
ZIP 31730
Phone 229 336-2976
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2025
Certificate Expiration Date 3/21/2027
Facility Type Pharmacy
Lab Director MACKEY STACI

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