21D2301849 CLIA NUMBER - WALGREENS #06779

Laboratory Demographics

  • CLIA Code: 21D2301849
  • Facility Name: WALGREENS #06779
  • Facility Address: 9616 HARFORD RD
    BALTIMORE, MD
    ZIP 21234
  • Facility Phone: 410 663-7957
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: VIVIAN NDUNGU
  • NPI Number: 1033124219
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2301849
LAB Type Pharmacy
Facility Name WALGREENS #06779
Street 9616 HARFORD RD
City BALTIMORE
State MD
ZIP 21234
Phone 410 663-7957
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/2/2024
Certificate Expiration Date 4/1/2026
Facility Type Pharmacy
Lab Director VIVIAN NDUNGU

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This page was last updated on: 3/20/2025