21D2061135 CLIA NUMBER - WALGREENS #12560

Laboratory Demographics

  • CLIA Code: 21D2061135
  • Facility Name: WALGREENS #12560
  • Facility Address: 1510 REISTERSTOWN ROAD
    PIKESVILLE, MD
    ZIP 21208
  • Facility Phone: 410 484-0196
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GLADYS G. ADETULA
  • NPI Number: 1760751432
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2061135
LAB Type Pharmacy
Facility Name WALGREENS #12560
Street 1510 REISTERSTOWN ROAD
City PIKESVILLE
State MD
ZIP 21208
Phone 410 484-0196
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 GLADYS G. ADETULA

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