36D2012210 CLIA NUMBER - WALGREENS #04294

Laboratory Demographics

  • CLIA Code: 36D2012210
  • Facility Name: WALGREENS #04294
  • Facility Address: 5881 SOM CENTER ROAD
    WILLOUGHBY, OH
    ZIP 44094
  • Facility Phone: 440 946-4357
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANDREW L. BRUINSMA
  • NPI Number: 1952316978
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2012210
LAB Type Pharmacy
Facility Name WALGREENS #04294
Street 5881 SOM CENTER ROAD
City WILLOUGHBY
State OH
ZIP 44094
Phone 440 946-4357
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/3/2023
Certificate Expiration Date 11/2/2025
Facility Type Pharmacy
Lab Director ANDREW L. BRUINSMA

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