49D2063691 CLIA NUMBER - WALGREENS # 13790

Laboratory Demographics

  • CLIA Code: 49D2063691
  • Facility Name: WALGREENS # 13790
  • Facility Address: 14095 JEFFERSON DAVIS HIGHWAY
    WOODBRIDGE, VA
    ZIP 22191
  • Facility Phone: 703 491-3630
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHELLE BEDIAKO
  • NPI Number: 1902148554
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D2063691
LAB Type Pharmacy
Facility Name WALGREENS # 13790
Street 14095 JEFFERSON DAVIS HIGHWAY
City WOODBRIDGE
State VA
ZIP 22191
Phone 703 491-3630
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/7/2025
Certificate Expiration Date 8/6/2027
Facility Type Pharmacy
Lab Director MICHELLE BEDIAKO

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