36D2012122 CLIA NUMBER - WALGREENS #04520

Laboratory Demographics

  • CLIA Code: 36D2012122
  • Facility Name: WALGREENS #04520
  • Facility Address: 1260 EAST CENTRAL AVENUE
    MIAMISBURG, OH
    ZIP 45342
  • Facility Phone: 937 859-3879
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRADLEY A. SCHAEFER
  • NPI Number: 1215942230
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2012122
LAB Type Pharmacy
Facility Name WALGREENS #04520
Street 1260 EAST CENTRAL AVENUE
City MIAMISBURG
State OH
ZIP 45342
Phone 937 859-3879
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/14/2025
Certificate Expiration Date 5/13/2027
Facility Type Pharmacy
Lab Director BRADLEY A. SCHAEFER

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