49D2040036 CLIA NUMBER - WALGREENS #13589

Laboratory Demographics

  • CLIA Code: 49D2040036
  • Facility Name: WALGREENS #13589
  • Facility Address: 225 MAPLE AVENUE EAST
    VIENNA, VA
    ZIP 22180
  • Facility Phone: 703 259-6342
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JENNIFER C. GRIZENKO
  • NPI Number: 1679800379
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D2040036
LAB Type Pharmacy
Facility Name WALGREENS #13589
Street 225 MAPLE AVENUE EAST
City VIENNA
State VA
ZIP 22180
Phone 703 259-6342
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/25/2025
Certificate Expiration Date 9/24/2027
Facility Type Pharmacy
Lab Director JENNIFER C. GRIZENKO

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