21D2290550 CLIA NUMBER - WALGREENS #17679

Laboratory Demographics

  • CLIA Code: 21D2290550
  • Facility Name: WALGREENS #17679
  • Facility Address: 3237 CHESTNUT RIDGE ROAD
    GRANTSVILLE, MD
    ZIP 21536
  • Facility Phone: 301 895-5315
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AARON HANZES
  • NPI Number: 1528582483
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2290550
LAB Type Pharmacy
Facility Name WALGREENS #17679
Street 3237 CHESTNUT RIDGE ROAD
City GRANTSVILLE
State MD
ZIP 21536
Phone 301 895-5315
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 AARON HANZES

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