42D2021168 CLIA NUMBER - WALGREENS # 09082

Laboratory Demographics

  • CLIA Code: 42D2021168
  • Facility Name: WALGREENS # 09082
  • Facility Address: 104 W BUTLER RD
    MAULDIN, SC
    ZIP 29662
  • Facility Phone: 864 297-0739
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TIMOTHY S. ELLIS
  • NPI Number: 1992710081
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 42D2021168
LAB Type Pharmacy
Facility Name WALGREENS # 09082
Street 104 W BUTLER RD
City MAULDIN
State SC
ZIP 29662
Phone 864 297-0739
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/30/2025
Certificate Expiration Date 7/29/2027
Facility Type Pharmacy
Lab Director TIMOTHY S. ELLIS

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