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11D2290436 CLIA NUMBER - WALGREENS 15611

Laboratory Demographics

CLIA Number: 11D2290436

Facility Name: WALGREENS 15611

Facility Address:
2109 E VICTORY DRIVE
SAVANNAH, GA
ZIP 31404
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Facility Phone Number: 912 354-2603

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1528481025

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 11D2290436
LAB Type Pharmacy
Facility Name WALGREENS 15611
Street 2109 E VICTORY DRIVE
City SAVANNAH
State GA
ZIP 31404
Phone 912 354-2603
CertificateType 4
CertificateEffectiveDate 9/26/2023
CertificateExpirationDate 9/25/2025
FacilityType Waiver

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