36D2011583 CLIA NUMBER - WALGREENS #09540

Laboratory Demographics

  • CLIA Code: 36D2011583
  • Facility Name: WALGREENS #09540
  • Facility Address: 4530 KENNY RD
    COLUMBUS, OH
    ZIP 43220
  • Facility Phone: 614 326-0689
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MIRA M. NUDEL
  • NPI Number: 1609881663
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2011583
LAB Type Pharmacy
Facility Name WALGREENS #09540
Street 4530 KENNY RD
City COLUMBUS
State OH
ZIP 43220
Phone 614 326-0689
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/28/2025
Certificate Expiration Date 7/27/2027
Facility Type Pharmacy
Lab Director MIRA M. NUDEL

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