21D2293328 CLIA NUMBER - WALGREENS #11054

Laboratory Demographics

  • CLIA Code: 21D2293328
  • Facility Name: WALGREENS #11054
  • Facility Address: 5319 PULASKI HWY
    PERRYVILLE, MD
    ZIP 21903
  • Facility Phone: 410 642-0003
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: OLUFUNMILOLA OLORUNFEMI
  • NPI Number: 1851311369
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2293328
LAB Type Pharmacy
Facility Name WALGREENS #11054
Street 5319 PULASKI HWY
City PERRYVILLE
State MD
ZIP 21903
Phone 410 642-0003
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/7/2023
Certificate Expiration Date 11/6/2025
Facility Type Pharmacy
Lab Director OLUFUNMILOLA OLORUNFEMI

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