21D2291002 CLIA NUMBER - WALGREENS #18096

Laboratory Demographics

  • CLIA Code: 21D2291002
  • Facility Name: WALGREENS #18096
  • Facility Address: 1321 RIVERSIDE PKWY
    BELCAMP, MD
    ZIP 21017
  • Facility Phone: 410 272-8741
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JESSA C. AVANCENA
  • NPI Number: 1588188254
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2291002
LAB Type Pharmacy
Facility Name WALGREENS #18096
Street 1321 RIVERSIDE PKWY
City BELCAMP
State MD
ZIP 21017
Phone 410 272-8741
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 JESSA C. AVANCENA

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