Healther Providers Data Logo

11D2291044 CLIA NUMBER - WALGREENS 10457

Laboratory Demographics

CLIA Number: 11D2291044

Facility Name: WALGREENS 10457

Facility Address:
5201 LAVISTA ROAD
TUCKER, GA
ZIP 30084
Get Directions

Facility Phone Number: 770 724-1042

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1720266737

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 11D2291044
LAB Type Pharmacy
Facility Name WALGREENS 10457
Street 5201 LAVISTA ROAD
City TUCKER
State GA
ZIP 30084
Phone 770 724-1042
CertificateType 4
CertificateEffectiveDate 10/4/2023
CertificateExpirationDate 10/3/2025
FacilityType Waiver

Download Record

Download this CLIA NUMBER record in Text format: Export

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

Download this CLIA NUMBER record in XML format: Export

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