44D1086038 CLIA NUMBER - WALGREENS #11113

Laboratory Demographics

  • CLIA Code: 44D1086038
  • Facility Name: WALGREENS #11113
  • Facility Address: 5104 BOBBY HICKS HWY
    GRAY, TN
    ZIP 37615
  • Facility Phone: 423 477-3372
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MOLLY M. KETRON
  • NPI Number: 1003002254
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 44D1086038
LAB Type Pharmacy
Facility Name WALGREENS #11113
Street 5104 BOBBY HICKS HWY
City GRAY
State TN
ZIP 37615
Phone 423 477-3372
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/27/2025
Certificate Expiration Date 3/26/2027
Facility Type Pharmacy
Lab Director MOLLY M. KETRON

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This page was last updated on: 6/4/2025