11D2218520 CLIA NUMBER - WALGREENS #17046

Laboratory Demographics

  • CLIA Code: 11D2218520
  • Facility Name: WALGREENS #17046
  • Facility Address: 2 WEST MAIN STREET
    CLAXTON, GA
    ZIP 30417
  • Facility Phone: 912 739-0406
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JUSTIN W. THOMAS
  • NPI Number: 1386168961
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2218520
LAB Type Pharmacy
Facility Name WALGREENS #17046
Street 2 WEST MAIN STREET
City CLAXTON
State GA
ZIP 30417
Phone 912 739-0406
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/29/2025
Certificate Expiration Date 3/28/2027
Facility Type Pharmacy
Lab Director JUSTIN W. THOMAS

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