36D2040994 CLIA NUMBER - WALGREENS #05639

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Laboratory Demographics

CLIA Number: 36D2040994

Facility Name: WALGREENS #05639

Facility Address:
320 SOUTH WATER STREET
KENT, OH
ZIP 44240
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Facility Phone Number: 330 677-5650

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1871508804

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	36D2040994
LAB Type	Pharmacy
Facility Name	WALGREENS #05639
Street	320 SOUTH WATER STREET
City	KENT
State	OH
ZIP	44240
Phone	330 677-5650
CertificateType	4
CertificateEffectiveDate	5/21/2023
CertificateExpirationDate	5/20/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024