36D1004254 CLIA NUMBER - MEIJER PHARMACY #102

Laboratory Demographics

  • CLIA Code: 36D1004254
  • Facility Name: MEIJER PHARMACY #102
  • Facility Address: 4075 WILMINGTON PIKE
    KETTERING, OH
    ZIP 45440
  • Facility Phone: 937 298-4220
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JACQUELINE MORSE
  • NPI Number: 1699830455
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D1004254
LAB Type Pharmacy
Facility Name MEIJER PHARMACY #102
Street 4075 WILMINGTON PIKE
City KETTERING
State OH
ZIP 45440
Phone 937 298-4220
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/23/2024
Certificate Expiration Date 9/22/2026
Facility Type Pharmacy
Lab Director JACQUELINE MORSE

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