34D2062761 CLIA NUMBER - WALGREENS #12046

Laboratory Demographics

  • CLIA Code: 34D2062761
  • Facility Name: WALGREENS #12046
  • Facility Address: 4211 NC 11 S
    WINTERVILLE, NC
    ZIP 28590
  • Facility Phone: 252 215-0467
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CORY FULCHER
  • NPI Number: 1720216641
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 34D2062761
LAB Type Pharmacy
Facility Name WALGREENS #12046
Street 4211 NC 11 S
City WINTERVILLE
State NC
ZIP 28590
Phone 252 215-0467
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/5/2025
Certificate Expiration Date 5/4/2027
Facility Type Pharmacy
Lab Director CORY FULCHER

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