21D2061101 CLIA NUMBER - WALGREENS #6265

Laboratory Demographics

  • CLIA Code: 21D2061101
  • Facility Name: WALGREENS #6265
  • Facility Address: 9110 LIBERTY ROAD
    RANDALLSTOWN, MD
    ZIP 21133
  • Facility Phone: 410 496-8146
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNY D. KWACK
  • NPI Number: 1689689861
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2061101
LAB Type Pharmacy
Facility Name WALGREENS #6265
Street 9110 LIBERTY ROAD
City RANDALLSTOWN
State MD
ZIP 21133
Phone 410 496-8146
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/27/2025
Certificate Expiration Date 9/26/2027
Facility Type Pharmacy
Lab Director KENNY D. KWACK

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