42D2218228 CLIA NUMBER - WALGREENS #17078

Laboratory Demographics

  • CLIA Code: 42D2218228
  • Facility Name: WALGREENS #17078
  • Facility Address: 515 SOUTH HAMPTON STREET
    KERSHAW, SC
    ZIP 29067
  • Facility Phone: 803 475-7370
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICA BLACKMON
  • NPI Number: 1255857108
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 42D2218228
LAB Type Pharmacy
Facility Name WALGREENS #17078
Street 515 SOUTH HAMPTON STREET
City KERSHAW
State SC
ZIP 29067
Phone 803 475-7370
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/26/2025
Certificate Expiration Date 3/25/2027
Facility Type Pharmacy
Lab Director MICA BLACKMON

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