49D2290567 CLIA NUMBER - WALGREENS 17465

Laboratory Demographics

  • CLIA Code: 49D2290567
  • Facility Name: WALGREENS 17465
  • Facility Address: 5230 PORT ROYAL ROAD
    SPRINGFIELD, VA
    ZIP 22151
  • Facility Phone: 703 321-8440
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KHOA M. NGUYEN
  • NPI Number: 1750806709
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D2290567
LAB Type Pharmacy
Facility Name WALGREENS 17465
Street 5230 PORT ROYAL ROAD
City SPRINGFIELD
State VA
ZIP 22151
Phone 703 321-8440
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/27/2025
Certificate Expiration Date 9/26/2027
Facility Type Pharmacy
Lab Director KHOA M. NGUYEN

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