21D2065968 CLIA NUMBER - WALGREENS #11057

Laboratory Demographics

  • CLIA Code: 21D2065968
  • Facility Name: WALGREENS #11057
  • Facility Address: 2440 CENTREVILLE ROAD
    CENTREVILLE, MD
    ZIP 21617
  • Facility Phone: 443 262-9640
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HEMANG J. RAWAL
  • NPI Number: 1962428425
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2065968
LAB Type Pharmacy
Facility Name WALGREENS #11057
Street 2440 CENTREVILLE ROAD
City CENTREVILLE
State MD
ZIP 21617
Phone 443 262-9640
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/13/2023
Certificate Expiration Date 12/12/2025
Facility Type Pharmacy
Lab Director HEMANG J. RAWAL

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This page was last updated on: 3/20/2025