36D2205382 CLIA NUMBER - WALGREENS #06119

Laboratory Demographics

  • CLIA Code: 36D2205382
  • Facility Name: WALGREENS #06119
  • Facility Address: 7900 E BROAD ST
    BLACKLICK, OH
    ZIP 43004
  • Facility Phone: 614 367-7923
  • Facility Type: Other - COVID-19 TEST SITE
  • Facility Type: Waiver
  • Lab Director: THOMPSON FOSU
  • NPI Number: 1073528006
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2205382
LAB Type Other - COVID-19 TEST SITE
Facility Name WALGREENS #06119
Street 7900 E BROAD ST
City BLACKLICK
State OH
ZIP 43004
Phone 614 367-7923
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/14/2024
Certificate Expiration Date 12/13/2026
Facility Type Other - COVID-19 TEST SITE
Lab Director THOMPSON FOSU

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