21D2061204 CLIA NUMBER - WALGREENS, #05638

Laboratory Demographics

  • CLIA Code: 21D2061204
  • Facility Name: WALGREENS, #05638
  • Facility Address: 4025 WEST NORTHERN PKWY
    BALTIMORE, MD
    ZIP 21215
  • Facility Phone: 410 764-9570
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARANATHA BAAH
  • NPI Number: 1366297285
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2061204
LAB Type Pharmacy
Facility Name WALGREENS, #05638
Street 4025 WEST NORTHERN PKWY
City BALTIMORE
State MD
ZIP 21215
Phone 410 764-9570
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/17/2024
Certificate Expiration Date 9/16/2026
Facility Type Pharmacy
Lab Director MARANATHA BAAH

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