21D2293376 CLIA NUMBER - WALGREENS #17905

Laboratory Demographics

  • CLIA Code: 21D2293376
  • Facility Name: WALGREENS #17905
  • Facility Address: 9150 BALTIMORE NATIONAL PIKE
    ELLICOTT CITY, MD
    ZIP 21042
  • Facility Phone: 410 465-4666
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SAMICHHYA PAUDEL
  • NPI Number: 1922522622
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2293376
LAB Type Pharmacy
Facility Name WALGREENS #17905
Street 9150 BALTIMORE NATIONAL PIKE
City ELLICOTT CITY
State MD
ZIP 21042
Phone 410 465-4666
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/8/2023
Certificate Expiration Date 11/7/2025
Facility Type Pharmacy
Lab Director SAMICHHYA PAUDEL

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