21D2301850 CLIA NUMBER - WALGREENS #17587

Laboratory Demographics

  • CLIA Code: 21D2301850
  • Facility Name: WALGREENS #17587
  • Facility Address: 6838 LOCH RAVEN BLVD
    BALTIMORE, MD
    ZIP 21286
  • Facility Phone: 410 825-8900
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NKEMDIRIM OHAMUO
  • NPI Number: 1740704568
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2301850
LAB Type Pharmacy
Facility Name WALGREENS #17587
Street 6838 LOCH RAVEN BLVD
City BALTIMORE
State MD
ZIP 21286
Phone 410 825-8900
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 NKEMDIRIM OHAMUO

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This page was last updated on: 6/4/2025