11D2229402 CLIA NUMBER - WALGREENS #17271

Laboratory Demographics

CLIA Number: 11D2229402

Facility Name: WALGREENS #17271

Facility Address:
140 FELTON DRIVE
ROCKMART, GA
ZIP 30153
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Facility Phone Number: 678 685-5181

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1154844975

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	11D2229402
LAB Type	Pharmacy
Facility Name	WALGREENS #17271
Street	140 FELTON DRIVE
City	ROCKMART
State	GA
ZIP	30153
Phone	678 685-5181
CertificateType	4
CertificateEffectiveDate	7/12/2023
CertificateExpirationDate	7/11/2025
FacilityType	Waiver

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