11D2241968 CLIA NUMBER - WALGREENS #19828

Laboratory Demographics

  • CLIA Code: 11D2241968
  • Facility Name: WALGREENS #19828
  • Facility Address: 305 W MAIN STREET
    MANCHESTER, GA
    ZIP 31816
  • Facility Phone: 706 846-8647
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RUSTI HOUSTON
  • NPI Number: 1295259620
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2241968
LAB Type Pharmacy
Facility Name WALGREENS #19828
Street 305 W MAIN STREET
City MANCHESTER
State GA
ZIP 31816
Phone 706 846-8647
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/3/2023
Certificate Expiration Date 11/2/2025
Facility Type Pharmacy
Lab Director RUSTI HOUSTON

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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