21D2061203 CLIA NUMBER - WALGREENS, #05623

Laboratory Demographics

  • CLIA Code: 21D2061203
  • Facility Name: WALGREENS, #05623
  • Facility Address: 3801 LIBERTY HEIGHTS AVENUE
    BALTIMORE, MD
    ZIP 21215
  • Facility Phone: 410 367-8100
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ADESUWA T. BENEDICT
  • NPI Number: 1629085709
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2061203
LAB Type Pharmacy
Facility Name WALGREENS, #05623
Street 3801 LIBERTY HEIGHTS AVENUE
City BALTIMORE
State MD
ZIP 21215
Phone 410 367-8100
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 ADESUWA T. BENEDICT

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This page was last updated on: 3/20/2025