51D2290399 CLIA NUMBER - WALGREENS 19653

Laboratory Demographics

  • CLIA Code: 51D2290399
  • Facility Name: WALGREENS 19653
  • Facility Address: 3801 MACCORKLE AVE SE
    CHARLESTON, WV
    ZIP 25304
  • Facility Phone: 304 925-2168
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MAXWELL S. SPRADLIN
  • NPI Number: 1649796061
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 51D2290399
LAB Type Pharmacy
Facility Name WALGREENS 19653
Street 3801 MACCORKLE AVE SE
City CHARLESTON
State WV
ZIP 25304
Phone 304 925-2168
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/26/2023
Certificate Expiration Date 9/25/2025
Facility Type Pharmacy
Lab Director MAXWELL S. SPRADLIN

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This page was last updated on: 6/4/2025