11D2226115 CLIA NUMBER - WALGREENS #17189

Laboratory Demographics

  • CLIA Code: 11D2226115
  • Facility Name: WALGREENS #17189
  • Facility Address: 975 HIGHWAY 54 W
    FAYETTEVILLE, GA
    ZIP 30214
  • Facility Phone: 770 719-3340
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHINEZE N. MBONU
  • NPI Number: 1437672219
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2226115
LAB Type Pharmacy
Facility Name WALGREENS #17189
Street 975 HIGHWAY 54 W
City FAYETTEVILLE
State GA
ZIP 30214
Phone 770 719-3340
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/26/2025
Certificate Expiration Date 5/25/2027
Facility Type Pharmacy
Lab Director CHINEZE N. MBONU

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