11D2290792 CLIA NUMBER - WALGREENS 18402

Laboratory Demographics

  • CLIA Code: 11D2290792
  • Facility Name: WALGREENS 18402
  • Facility Address: 131 SOUTH MAIN STREET
    HIAWASSEE, GA
    ZIP 30546
  • Facility Phone: 706 896-2255
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DUSTIN A. CONSTOCK
  • NPI Number: 1205350840
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2290792
LAB Type Pharmacy
Facility Name WALGREENS 18402
Street 131 SOUTH MAIN STREET
City HIAWASSEE
State GA
ZIP 30546
Phone 706 896-2255
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/2/2025
Certificate Expiration Date 10/1/2027
Facility Type Pharmacy
Lab Director DUSTIN A. CONSTOCK

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