36D2011778 CLIA NUMBER - WALGREENS #11143

Laboratory Demographics

  • CLIA Code: 36D2011778
  • Facility Name: WALGREENS #11143
  • Facility Address: 3009 WEST MARKET STREET
    FAIRLAWN, OH
    ZIP 44333
  • Facility Phone: 330 867-1946
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LUCAS A. MITZEL
  • NPI Number: 1750650925
  • Taxonomy: 305R00000X - Preferred Provider Organization

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CLIA Record

Field Name Field Value
CLIA Number 36D2011778
LAB Type Pharmacy
Facility Name WALGREENS #11143
Street 3009 WEST MARKET STREET
City FAIRLAWN
State OH
ZIP 44333
Phone 330 867-1946
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/17/2025
Certificate Expiration Date 5/16/2027
Facility Type Pharmacy
Lab Director LUCAS A. MITZEL

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