21D2301851 CLIA NUMBER - WALGREENS #15553

Laboratory Demographics

  • CLIA Code: 21D2301851
  • Facility Name: WALGREENS #15553
  • Facility Address: 10097 BALTIMORE NATIONAL PIKE
    ELLICOTT CITY, MD
    ZIP 21042
  • Facility Phone: 443 973-3339
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TUYET NHUNG TRAN
  • NPI Number: 1013317650
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2301851
LAB Type Physician Office
Facility Name WALGREENS #15553
Street 10097 BALTIMORE NATIONAL PIKE
City ELLICOTT CITY
State MD
ZIP 21042
Phone 443 973-3339
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 Physician Office
Lab Director TUYET NHUNG TRAN

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