36D2011769 CLIA NUMBER - WALGREENS #04101

Laboratory Demographics

  • CLIA Code: 36D2011769
  • Facility Name: WALGREENS #04101
  • Facility Address: 5122 TUSCARAWAS STREET WEST
    CANTON, OH
    ZIP 44708
  • Facility Phone: 330 478-3976
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DANIEL W. KELLER
  • NPI Number: 1134134158
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2011769
LAB Type Pharmacy
Facility Name WALGREENS #04101
Street 5122 TUSCARAWAS STREET WEST
City CANTON
State OH
ZIP 44708
Phone 330 478-3976
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2023
Certificate Expiration Date 4/19/2025
Facility Type Pharmacy
Lab Director DANIEL W. KELLER

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This page was last updated on: 3/20/2025