21D2293384 CLIA NUMBER - WALGREENS #17928

Laboratory Demographics

  • CLIA Code: 21D2293384
  • Facility Name: WALGREENS #17928
  • Facility Address: 662 QUINCE ORCHARD RD
    GAITHERSBURG, MD
    ZIP 20878
  • Facility Phone: 301 990-6993
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ULICES DOMINGUEZ
  • NPI Number: 1891210365
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2293384
LAB Type Pharmacy
Facility Name WALGREENS #17928
Street 662 QUINCE ORCHARD RD
City GAITHERSBURG
State MD
ZIP 20878
Phone 301 990-6993
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 ULICES DOMINGUEZ

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