49D2040001 CLIA NUMBER - WALGREENS #10712

Laboratory Demographics

  • CLIA Code: 49D2040001
  • Facility Name: WALGREENS #10712
  • Facility Address: 10320 MAIN STREET
    FAIRFAX, VA
    ZIP 22030
  • Facility Phone: 703 591-1025
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: IVY KWAPONG
  • NPI Number: 1245447390
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D2040001
LAB Type Pharmacy
Facility Name WALGREENS #10712
Street 10320 MAIN STREET
City FAIRFAX
State VA
ZIP 22030
Phone 703 591-1025
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2024
Certificate Expiration Date 4/19/2026
Facility Type Pharmacy
Lab Director IVY KWAPONG

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