49D2221710 CLIA NUMBER - WALGREENS #18211

Laboratory Demographics

  • CLIA Code: 49D2221710
  • Facility Name: WALGREENS #18211
  • Facility Address: 11129 GORDON RD
    FREDERICKSBURG, VA
    ZIP 22407
  • Facility Phone: 540 785-6634
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NGA T. PHAM
  • NPI Number: 1952829194
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D2221710
LAB Type Pharmacy
Facility Name WALGREENS #18211
Street 11129 GORDON RD
City FREDERICKSBURG
State VA
ZIP 22407
Phone 540 785-6634
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/23/2025
Certificate Expiration Date 4/22/2027
Facility Type Pharmacy
Lab Director NGA T. PHAM

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