20D2199476 CLIA NUMBER - WALGREENS #11373

Laboratory Demographics

  • CLIA Code: 20D2199476
  • Facility Name: WALGREENS #11373
  • Facility Address: 403 WATER STREET
    AUGUSTA, ME
    ZIP 04330
  • Facility Phone: 207 629-9401
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SHANTAN REDDY
  • NPI Number: 1982861811
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 20D2199476
LAB Type Pharmacy
Facility Name WALGREENS #11373
Street 403 WATER STREET
City AUGUSTA
State ME
ZIP 04330
Phone 207 629-9401
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/9/2024
Certificate Expiration Date 11/8/2026
Facility Type Pharmacy
Lab Director SHANTAN REDDY

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This page was last updated on: 6/4/2025