21D2061209 CLIA NUMBER - WALGREENS #13892

Laboratory Demographics

  • CLIA Code: 21D2061209
  • Facility Name: WALGREENS #13892
  • Facility Address: 17703 VIRGINIA AVE
    HAGERSTOWN, MD
    ZIP 21740
  • Facility Phone: 240 420-5310
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RODNEY M. LUMOR
  • NPI Number: 1346588589
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2061209
LAB Type Pharmacy
Facility Name WALGREENS #13892
Street 17703 VIRGINIA AVE
City HAGERSTOWN
State MD
ZIP 21740
Phone 240 420-5310
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/8/2023
Certificate Expiration Date 11/7/2025
Facility Type Pharmacy
Lab Director RODNEY M. LUMOR

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