36D2055746 CLIA NUMBER - WALGREENS #09047

Laboratory Demographics

  • CLIA Code: 36D2055746
  • Facility Name: WALGREENS #09047
  • Facility Address: 1000 PARK AVE W
    MANSFIELD, OH
    ZIP 44906
  • Facility Phone: 419 529-3790
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ERICA LAFORTE
  • NPI Number: 1972518934
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2055746
LAB Type Pharmacy
Facility Name WALGREENS #09047
Street 1000 PARK AVE W
City MANSFIELD
State OH
ZIP 44906
Phone 419 529-3790
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/28/2025
Certificate Expiration Date 7/27/2027
Facility Type Pharmacy
Lab Director ERICA LAFORTE

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