42D2046604 CLIA NUMBER - WALGREENS #11564

Laboratory Demographics

  • CLIA Code: 42D2046604
  • Facility Name: WALGREENS #11564
  • Facility Address: 7686 CHARLOTTE HWY
    INDIAN LAND, SC
    ZIP 29707
  • Facility Phone: 803 548-9201
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PATRICIA A. REYNOLDS
  • NPI Number: 1538394671
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 42D2046604
LAB Type Pharmacy
Facility Name WALGREENS #11564
Street 7686 CHARLOTTE HWY
City INDIAN LAND
State SC
ZIP 29707
Phone 803 548-9201
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/3/2025
Certificate Expiration Date 8/2/2027
Facility Type Pharmacy
Lab Director PATRICIA A. REYNOLDS

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