21D2061198 CLIA NUMBER - WALGREENS, #05408

Laboratory Demographics

  • CLIA Code: 21D2061198
  • Facility Name: WALGREENS, #05408
  • Facility Address: 1300 EAST NORTH AVENUE
    BALTIMORE, MD
    ZIP 21213
  • Facility Phone: 410 889-1359
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: COLLINS EDUSEI
  • NPI Number: 1497760672
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2061198
LAB Type Pharmacy
Facility Name WALGREENS, #05408
Street 1300 EAST NORTH AVENUE
City BALTIMORE
State MD
ZIP 21213
Phone 410 889-1359
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/13/2023
Certificate Expiration Date 12/12/2025
Facility Type Pharmacy
Lab Director COLLINS EDUSEI

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This page was last updated on: 6/4/2025