36D2121415 CLIA NUMBER - JACKSON PHARMACY & WELLNESS CENTER

Laboratory Demographics

  • CLIA Code: 36D2121415
  • Facility Name: JACKSON PHARMACY & WELLNESS CENTER
  • Facility Address: 101B E PIKE STREET
    JACKSON CENTER, OH
    ZIP 45334
  • Facility Phone: 937 596-8100
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALISON L. HAAS
  • NPI Number: 1215351077
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2121415
LAB Type Pharmacy
Facility Name JACKSON PHARMACY & WELLNESS CENTER
Street 101B E PIKE STREET
City JACKSON CENTER
State OH
ZIP 45334
Phone 937 596-8100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/4/2024
Certificate Expiration Date 11/3/2026
Facility Type Pharmacy
Lab Director ALISON L. HAAS

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