36D2008167 CLIA NUMBER - WALGREENS #11510

Laboratory Demographics

  • CLIA Code: 36D2008167
  • Facility Name: WALGREENS #11510
  • Facility Address: 2269 N FAIRFIELD RD
    BEAVERCREEK, OH
    ZIP 45431
  • Facility Phone: 937 320-9112
  • Facility Type: Other - COVID-19 TEST SITE
  • Facility Type: Waiver
  • Lab Director: TYLER PHILO
  • NPI Number: 1699923193
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2008167
LAB Type Other - COVID-19 TEST SITE
Facility Name WALGREENS #11510
Street 2269 N FAIRFIELD RD
City BEAVERCREEK
State OH
ZIP 45431
Phone 937 320-9112
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/14/2024
Certificate Expiration Date 12/13/2026
Facility Type Other - COVID-19 TEST SITE
Lab Director TYLER PHILO

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