36D2183060 CLIA NUMBER - MADISON AVENUE PHARMACY, INC

Laboratory Demographics

  • CLIA Code: 36D2183060
  • Facility Name: MADISON AVENUE PHARMACY, INC
  • Facility Address: 640 N FOUNTAIN AVE
    SPRINGFIELD, OH
    ZIP 45504
  • Facility Phone: 937 323-1841
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ERIC T. JUERGENS
  • NPI Number: 1407930530
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2183060
LAB Type Pharmacy
Facility Name MADISON AVENUE PHARMACY, INC
Street 640 N FOUNTAIN AVE
City SPRINGFIELD
State OH
ZIP 45504
Phone 937 323-1841
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/29/2024
Certificate Expiration Date 4/28/2026
Facility Type Pharmacy
Lab Director ERIC T. JUERGENS

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