21D2292837 CLIA NUMBER - WALGREENS #18160

Laboratory Demographics

  • CLIA Code: 21D2292837
  • Facility Name: WALGREENS #18160
  • Facility Address: 3400 MOUNTAIN ROAD
    PASADENA, MD
    ZIP 21122
  • Facility Phone: 410 360-1509
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PEFOK F. OMOLOLA
  • NPI Number: 1063936938
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2292837
LAB Type Pharmacy
Facility Name WALGREENS #18160
Street 3400 MOUNTAIN ROAD
City PASADENA
State MD
ZIP 21122
Phone 410 360-1509
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 PEFOK F. OMOLOLA

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