49D2290569 CLIA NUMBER - WALGREENS 17487

Laboratory Demographics

  • CLIA Code: 49D2290569
  • Facility Name: WALGREENS 17487
  • Facility Address: 9125 POCAHONTAS TRAIL
    PROVIDENCE FORGE, VA
    ZIP 23140
  • Facility Phone: 804 966-2151
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SARAH M. TANTILLO
  • NPI Number: 1609399419
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D2290569
LAB Type Pharmacy
Facility Name WALGREENS 17487
Street 9125 POCAHONTAS TRAIL
City PROVIDENCE FORGE
State VA
ZIP 23140
Phone 804 966-2151
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 SARAH M. TANTILLO

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