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11D2287314 CLIA NUMBER - WALGREENS 19561

Laboratory Demographics

CLIA Number: 11D2287314

Facility Name: WALGREENS 19561

Facility Address:
1235 WASHINGTON STREET
CLARKESVILLE, GA
ZIP 30523
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Facility Phone Number: 706 754-4122

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1972028645

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 11D2287314
LAB Type Pharmacy
Facility Name WALGREENS 19561
Street 1235 WASHINGTON STREET
City CLARKESVILLE
State GA
ZIP 30523
Phone 706 754-4122
CertificateType 4
CertificateEffectiveDate 8/11/2023
CertificateExpirationDate 8/10/2025
FacilityType Waiver

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