21D2061206 CLIA NUMBER - WALGREENS # 5686

Laboratory Demographics

  • CLIA Code: 21D2061206
  • Facility Name: WALGREENS # 5686
  • Facility Address: 401 COMPASS ROAD, EAST
    BALTIMORE, MD
    ZIP 21220
  • Facility Phone: 410 780-4770
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DIVINE KEBULU
  • NPI Number: 1861407041
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2061206
LAB Type Pharmacy
Facility Name WALGREENS # 5686
Street 401 COMPASS ROAD, EAST
City BALTIMORE
State MD
ZIP 21220
Phone 410 780-4770
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/14/2023
Certificate Expiration Date 11/13/2025
Facility Type Pharmacy
Lab Director DIVINE KEBULU

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