36D2184481 CLIA NUMBER - GENESIS ROSEVILLE PHARMACY

Laboratory Demographics

  • CLIA Code: 36D2184481
  • Facility Name: GENESIS ROSEVILLE PHARMACY
  • Facility Address: 157 S MAIN STREET
    ROSEVILLE, OH
    ZIP 43777
  • Facility Phone: 740 697-0348
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARK A. HENDRICKSON
  • NPI Number: 1861449043
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2184481
LAB Type Pharmacy
Facility Name GENESIS ROSEVILLE PHARMACY
Street 157 S MAIN STREET
City ROSEVILLE
State OH
ZIP 43777
Phone 740 697-0348
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/20/2024
Certificate Expiration Date 5/19/2026
Facility Type Pharmacy
Lab Director MARK A. HENDRICKSON

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