36D2217262 CLIA NUMBER - WALGREENS #12703

Laboratory Demographics

  • CLIA Code: 36D2217262
  • Facility Name: WALGREENS #12703
  • Facility Address: 537 W MAIN ST
    XENIA, OH
    ZIP 45385
  • Facility Phone: 937 376-0631
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALAA A. ESMAIL
  • NPI Number: 1427298538
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2217262
LAB Type Pharmacy
Facility Name WALGREENS #12703
Street 537 W MAIN ST
City XENIA
State OH
ZIP 45385
Phone 937 376-0631
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/19/2025
Certificate Expiration Date 3/18/2027
Facility Type Pharmacy
Lab Director ALAA A. ESMAIL

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