42D2012793 CLIA NUMBER - WALGREENS #02452

Laboratory Demographics

  • CLIA Code: 42D2012793
  • Facility Name: WALGREENS #02452
  • Facility Address: 2811 N MAIN ST
    ANDERSON, SC
    ZIP 29621
  • Facility Phone: 864 225-2321
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHAEL A. OLSOMMER
  • NPI Number: 1801311550
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 42D2012793
LAB Type Pharmacy
Facility Name WALGREENS #02452
Street 2811 N MAIN ST
City ANDERSON
State SC
ZIP 29621
Phone 864 225-2321
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/17/2025
Certificate Expiration Date 6/16/2027
Facility Type Pharmacy
Lab Director MICHAEL A. OLSOMMER

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