36D2012209 CLIA NUMBER - WALGREENS #04317

Laboratory Demographics

  • CLIA Code: 36D2012209
  • Facility Name: WALGREENS #04317
  • Facility Address: 9400 MENTOR AVENUE
    MENTOR, OH
    ZIP 44060
  • Facility Phone: 440 255-6247
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STEPHANIE RONCALLI
  • NPI Number: 1306851324
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2012209
LAB Type Pharmacy
Facility Name WALGREENS #04317
Street 9400 MENTOR AVENUE
City MENTOR
State OH
ZIP 44060
Phone 440 255-6247
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/13/2025
Certificate Expiration Date 10/12/2027
Facility Type Pharmacy
Lab Director STEPHANIE RONCALLI

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