11D2244881 CLIA NUMBER - VILLA RICA DRUGS

Laboratory Demographics

  • CLIA Code: 11D2244881
  • Facility Name: VILLA RICA DRUGS
  • Facility Address: 222 WEST WILSON STREET
    VILLA RICA, GA
    ZIP 30180
  • Facility Phone: 770 456-4663
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: COLTON BLACKMON
  • NPI Number: 1619262433
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2244881
LAB Type Pharmacy
Facility Name VILLA RICA DRUGS
Street 222 WEST WILSON STREET
City VILLA RICA
State GA
ZIP 30180
Phone 770 456-4663
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/7/2023
Certificate Expiration Date 12/6/2025
Facility Type Pharmacy
Lab Director COLTON BLACKMON

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