21D2290991 CLIA NUMBER - WALGREENS #18165

Laboratory Demographics

  • CLIA Code: 21D2290991
  • Facility Name: WALGREENS #18165
  • Facility Address: 355 MARKET SQUARE DRIVE
    PRINCE FREDERICK, MD
    ZIP 20678
  • Facility Phone: 410 535-5313
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TAYLOR N. MUTCHLER
  • NPI Number: 1013433770
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2290991
LAB Type Pharmacy
Facility Name WALGREENS #18165
Street 355 MARKET SQUARE DRIVE
City PRINCE FREDERICK
State MD
ZIP 20678
Phone 410 535-5313
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/4/2025
Certificate Expiration Date 10/3/2027
Facility Type Pharmacy
Lab Director TAYLOR N. MUTCHLER

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