21D2061160 CLIA NUMBER - WALGREENS #11501

Laboratory Demographics

  • CLIA Code: 21D2061160
  • Facility Name: WALGREENS #11501
  • Facility Address: 496 RITCHIE HWY
    SEVERNA PARK, MD
    ZIP 21146
  • Facility Phone: 410 544-1291
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BLANCHE M. NDIFON
  • NPI Number: 1386887925
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2061160
LAB Type Pharmacy
Facility Name WALGREENS #11501
Street 496 RITCHIE HWY
City SEVERNA PARK
State MD
ZIP 21146
Phone 410 544-1291
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/7/2023
Certificate Expiration Date 11/6/2025
Facility Type Pharmacy
Lab Director BLANCHE M. NDIFON

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