21D2061119 CLIA NUMBER - WALGREENS #12790

Laboratory Demographics

  • CLIA Code: 21D2061119
  • Facility Name: WALGREENS #12790
  • Facility Address: 6323 BALTIMORE NATIONAL PIKE
    CATONSVILLE, MD
    ZIP 21228
  • Facility Phone: 410 744-0306
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MAYANK V. VAGHASIYA
  • NPI Number: 1508173394
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2061119
LAB Type Pharmacy
Facility Name WALGREENS #12790
Street 6323 BALTIMORE NATIONAL PIKE
City CATONSVILLE
State MD
ZIP 21228
Phone 410 744-0306
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 MAYANK V. VAGHASIYA

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