21D2061103 CLIA NUMBER - WALGREENS #12472

Laboratory Demographics

  • CLIA Code: 21D2061103
  • Facility Name: WALGREENS #12472
  • Facility Address: 7008 MARLBORO PIKE
    FORESTVILLE, MD
    ZIP 20747
  • Facility Phone: 301 420-3240
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ADEPERO E. ODUSANYA
  • NPI Number: 1205122991
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2061103
LAB Type Pharmacy
Facility Name WALGREENS #12472
Street 7008 MARLBORO PIKE
City FORESTVILLE
State MD
ZIP 20747
Phone 301 420-3240
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 ADEPERO E. ODUSANYA

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