11D2239564 CLIA NUMBER - WALGREENS #17194

Laboratory Demographics

  • CLIA Code: 11D2239564
  • Facility Name: WALGREENS #17194
  • Facility Address: 3687 HIGHWAY 5
    DOUGLASVILLE, GA
    ZIP 30135
  • Facility Phone: 770 577-8979
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHELLE QUESRIEL
  • NPI Number: 1912420712
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2239564
LAB Type Pharmacy
Facility Name WALGREENS #17194
Street 3687 HIGHWAY 5
City DOUGLASVILLE
State GA
ZIP 30135
Phone 770 577-8979
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/13/2025
Certificate Expiration Date 10/12/2027
Facility Type Pharmacy
Lab Director MICHELLE QUESRIEL

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