11D2225011 CLIA NUMBER - WALGREENS #12756

Laboratory Demographics

  • CLIA Code: 11D2225011
  • Facility Name: WALGREENS #12756
  • Facility Address: 2025 1ST AVENUE SE
    MOULTRIE, GA
    ZIP 31788
  • Facility Phone: 229 890-2776
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KAYLA MARSHALL
  • NPI Number: 1457693004
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2225011
LAB Type Pharmacy
Facility Name WALGREENS #12756
Street 2025 1ST AVENUE SE
City MOULTRIE
State GA
ZIP 31788
Phone 229 890-2776
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/18/2025
Certificate Expiration Date 5/17/2027
Facility Type Pharmacy
Lab Director KAYLA MARSHALL

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