21D2292833 CLIA NUMBER - WALGREENS #17638

Laboratory Demographics

  • CLIA Code: 21D2292833
  • Facility Name: WALGREENS #17638
  • Facility Address: 10134 RIVER RD
    POTOMAC, MD
    ZIP 20854
  • Facility Phone: 301 299-8600
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SARAH R. DEPTULA
  • NPI Number: 1972029635
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2292833
LAB Type Pharmacy
Facility Name WALGREENS #17638
Street 10134 RIVER RD
City POTOMAC
State MD
ZIP 20854
Phone 301 299-8600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/31/2023
Certificate Expiration Date 10/30/2025
Facility Type Pharmacy
Lab Director SARAH R. DEPTULA

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This page was last updated on: 3/20/2025