11D2239330 CLIA NUMBER - WALGREENS #19880

Laboratory Demographics

CLIA Number: 11D2239330

Facility Name: WALGREENS #19880

Facility Address:
301 S BROAD STREET
THOMASVILLE, GA
ZIP 31792
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Facility Phone Number: 229 228-7658

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1407370042

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	11D2239330
LAB Type	Pharmacy
Facility Name	WALGREENS #19880
Street	301 S BROAD STREET
City	THOMASVILLE
State	GA
ZIP	31792
Phone	229 228-7658
CertificateType	4
CertificateEffectiveDate	10/12/2023
CertificateExpirationDate	10/11/2025
FacilityType	Waiver

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