21D2061406 CLIA NUMBER - WALGREENS #10539

Laboratory Demographics

  • CLIA Code: 21D2061406
  • Facility Name: WALGREENS #10539
  • Facility Address: 12400 AUTO DR
    CLARKSVILLE, MD
    ZIP 21029
  • Facility Phone: 410 531-6030
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: POH PHAM
  • NPI Number: 1427231646
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2061406
LAB Type Pharmacy
Facility Name WALGREENS #10539
Street 12400 AUTO DR
City CLARKSVILLE
State MD
ZIP 21029
Phone 410 531-6030
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/27/2025
Certificate Expiration Date 9/26/2027
Facility Type Pharmacy
Lab Director POH PHAM

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