21D2290554 CLIA NUMBER - WALGREENS #17619

Laboratory Demographics

  • CLIA Code: 21D2290554
  • Facility Name: WALGREENS #17619
  • Facility Address: 1600 E CHURCHVILLE RD
    BEL AIR, MD
    ZIP 21015
  • Facility Phone: 410 836-9628
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CASSANDRA BUTLER
  • NPI Number: 1932624665
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2290554
LAB Type Pharmacy
Facility Name WALGREENS #17619
Street 1600 E CHURCHVILLE RD
City BEL AIR
State MD
ZIP 21015
Phone 410 836-9628
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 CASSANDRA BUTLER

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