36D2041030 CLIA NUMBER - WALGREENS #10579

Laboratory Demographics

  • CLIA Code: 36D2041030
  • Facility Name: WALGREENS #10579
  • Facility Address: 403 SOUTH MAIN STREET
    BRYAN, OH
    ZIP 43506
  • Facility Phone: 419 636-0613
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AUSTIN M. MILES
  • NPI Number: 1164629903
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2041030
LAB Type Pharmacy
Facility Name WALGREENS #10579
Street 403 SOUTH MAIN STREET
City BRYAN
State OH
ZIP 43506
Phone 419 636-0613
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/9/2025
Certificate Expiration Date 3/8/2027
Facility Type Pharmacy
Lab Director AUSTIN M. MILES

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