21D2290993 CLIA NUMBER - WALGREENS #17522

Laboratory Demographics

CLIA Number: 21D2290993

Facility Name: WALGREENS #17522

Facility Address:
238 MCMECHEN STREET
BALTIMORE, MD
ZIP 21217
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Facility Phone Number: 410 523-4704

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1396269106

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	21D2290993
LAB Type	Pharmacy
Facility Name	WALGREENS #17522
Street	238 MCMECHEN STREET
City	BALTIMORE
State	MD
ZIP	21217
Phone	410 523-4704
CertificateType	4
CertificateEffectiveDate	10/4/2023
CertificateExpirationDate	10/3/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024