36D2191037 CLIA NUMBER - WALGREENS #12476

Laboratory Demographics

  • CLIA Code: 36D2191037
  • Facility Name: WALGREENS #12476
  • Facility Address: 521 E MAIN ST
    JACKSON, OH
    ZIP 45640
  • Facility Phone: 937 219-3096
  • Facility Type: Other - COVID-19 TEST SITE
  • Facility Type: Waiver
  • Lab Director: MICHAEL E. BOWMAN
  • NPI Number: 1740434794
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2191037
LAB Type Other - COVID-19 TEST SITE
Facility Name WALGREENS #12476
Street 521 E MAIN ST
City JACKSON
State OH
ZIP 45640
Phone 937 219-3096
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/21/2024
Certificate Expiration Date 8/20/2026
Facility Type Other - COVID-19 TEST SITE
Lab Director MICHAEL E. BOWMAN

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