21D2061420 CLIA NUMBER - WALGREENS #11140

Laboratory Demographics

  • CLIA Code: 21D2061420
  • Facility Name: WALGREENS #11140
  • Facility Address: 1329 UNIVERSITY BLVD, E
    TAKOMA PARK, MD
    ZIP 20912
  • Facility Phone: 301 445-8159
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BEZAWIT AYENACHEW
  • NPI Number: 1932404746
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2061420
LAB Type Pharmacy
Facility Name WALGREENS #11140
Street 1329 UNIVERSITY BLVD, E
City TAKOMA PARK
State MD
ZIP 20912
Phone 301 445-8159
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/31/2023
Certificate Expiration Date 10/30/2025
Facility Type Pharmacy
Lab Director BEZAWIT AYENACHEW

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