11D2229464 CLIA NUMBER - WALGREENS #17083

Laboratory Demographics

  • CLIA Code: 11D2229464
  • Facility Name: WALGREENS #17083
  • Facility Address: 633 NORTH MAIN STREET
    CEDARTOWN, GA
    ZIP 30125
  • Facility Phone: 770 748-5030
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CONNIE S. BROWN
  • NPI Number: 1316462906
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2229464
LAB Type Pharmacy
Facility Name WALGREENS #17083
Street 633 NORTH MAIN STREET
City CEDARTOWN
State GA
ZIP 30125
Phone 770 748-5030
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/13/2025
Certificate Expiration Date 7/12/2027
Facility Type Pharmacy
Lab Director CONNIE S. BROWN

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