21D2293773 CLIA NUMBER - WALGREENS #19380

Laboratory Demographics

CLIA Number: 21D2293773

Facility Name: WALGREENS #19380

Facility Address:
6970 CRESTWOOD BLVD
FREDERICK, MD
ZIP 21703
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Facility Phone Number: 301 682-9158

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1093230583

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	21D2293773
LAB Type	Pharmacy
Facility Name	WALGREENS #19380
Street	6970 CRESTWOOD BLVD
City	FREDERICK
State	MD
ZIP	21703
Phone	301 682-9158
CertificateType	4
CertificateEffectiveDate	11/15/2023
CertificateExpirationDate	11/14/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024