49D2054210 CLIA NUMBER - WALGREENS #12167

Laboratory Demographics

  • CLIA Code: 49D2054210
  • Facility Name: WALGREENS #12167
  • Facility Address: 9150 DEWIN ROAD
    BRISTOW, VA
    ZIP 20136
  • Facility Phone: 703 369-2049
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRYAN M. BENSON
  • NPI Number: 1134498892
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D2054210
LAB Type Pharmacy
Facility Name WALGREENS #12167
Street 9150 DEWIN ROAD
City BRISTOW
State VA
ZIP 20136
Phone 703 369-2049
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/23/2025
Certificate Expiration Date 3/22/2027
Facility Type Pharmacy
Lab Director BRYAN M. BENSON

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