11D2291044 CLIA NUMBER - WALGREENS 10457

Laboratory Demographics

  • CLIA Code: 11D2291044
  • Facility Name: WALGREENS 10457
  • Facility Address: 5201 LAVISTA ROAD
    TUCKER, GA
    ZIP 30084
  • Facility Phone: 770 724-1042
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SHIRLEY R. PELTRO
  • NPI Number: 1720266737
  • Taxonomy: 333600000X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/4/2025
Certificate Expiration Date 10/3/2027
Facility Type Pharmacy
Lab Director SHIRLEY R. PELTRO

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