21D2061158 CLIA NUMBER - WALGREENS #10402

Laboratory Demographics

  • CLIA Code: 21D2061158
  • Facility Name: WALGREENS #10402
  • Facility Address: 11745 ROUSBY HALL ROAD
    LUSBY, MD
    ZIP 20657
  • Facility Phone: 410 394-2730
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SHANNON DOUGLAS
  • NPI Number: 1639366651
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2061158
LAB Type Pharmacy
Facility Name WALGREENS #10402
Street 11745 ROUSBY HALL ROAD
City LUSBY
State MD
ZIP 20657
Phone 410 394-2730
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 SHANNON DOUGLAS

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