42D2206834 CLIA NUMBER - WALGREENS #11968

Laboratory Demographics

  • CLIA Code: 42D2206834
  • Facility Name: WALGREENS #11968
  • Facility Address: 1250 TOM HALL ST
    FORT MILL, SC
    ZIP 29715
  • Facility Phone: 704 301-7964
  • Facility Type: Other - COVID TESTING
  • Facility Type: Waiver
  • Lab Director: STACEY A. KYZER
  • NPI Number: 1194057927
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 42D2206834
LAB Type Other - COVID TESTING
Facility Name WALGREENS #11968
Street 1250 TOM HALL ST
City FORT MILL
State SC
ZIP 29715
Phone 704 301-7964
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/22/2024
Certificate Expiration Date 12/21/2026
Facility Type Other - COVID TESTING
Lab Director STACEY A. KYZER

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