51D2233997 CLIA NUMBER - WALGREENS #17738

Laboratory Demographics

  • CLIA Code: 51D2233997
  • Facility Name: WALGREENS #17738
  • Facility Address: 333 MACCORKLE AVENUE SW
    SOUTH CHARLESTON, WV
    ZIP 25303
  • Facility Phone: 304 744-8362
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TRISTAN MAYNARD
  • NPI Number: 1841716560
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 51D2233997
LAB Type Pharmacy
Facility Name WALGREENS #17738
Street 333 MACCORKLE AVENUE SW
City SOUTH CHARLESTON
State WV
ZIP 25303
Phone 304 744-8362
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/27/2025
Certificate Expiration Date 8/26/2027
Facility Type Pharmacy
Lab Director TRISTAN MAYNARD

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