21D2295523 CLIA NUMBER - WALGREENS #19843

Laboratory Demographics

  • CLIA Code: 21D2295523
  • Facility Name: WALGREENS #19843
  • Facility Address: 8491 FORT SMALLWOOD ROAD
    PASADENA, MD
    ZIP 21122
  • Facility Phone: 410 255-5361
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LIVINGSTONE D. MWANGOMBE
  • NPI Number: 1174047807
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2295523
LAB Type Pharmacy
Facility Name WALGREENS #19843
Street 8491 FORT SMALLWOOD ROAD
City PASADENA
State MD
ZIP 21122
Phone 410 255-5361
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/13/2023
Certificate Expiration Date 12/12/2025
Facility Type Pharmacy
Lab Director LIVINGSTONE D. MWANGOMBE

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