11D2229408 CLIA NUMBER - WALGREENS #17686

Laboratory Demographics

  • CLIA Code: 11D2229408
  • Facility Name: WALGREENS #17686
  • Facility Address: 954 JOE FRANK HARRIS PARKWAY
    CARTERSVILLE, GA
    ZIP 30120
  • Facility Phone: 770 383-3055
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SHAWN WALLACE
  • NPI Number: 1053834895
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2229408
LAB Type Pharmacy
Facility Name WALGREENS #17686
Street 954 JOE FRANK HARRIS PARKWAY
City CARTERSVILLE
State GA
ZIP 30120
Phone 770 383-3055
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/12/2025
Certificate Expiration Date 7/11/2027
Facility Type Pharmacy
Lab Director SHAWN WALLACE

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