36D2217406 CLIA NUMBER - WALGREENS #11966

Laboratory Demographics

  • CLIA Code: 36D2217406
  • Facility Name: WALGREENS #11966
  • Facility Address: 180 COLEMANS XING
    MARYSVILLE, OH
    ZIP 43040
  • Facility Phone: 937 578-0156
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KEVIN S. HAMMOND
  • NPI Number: 1952579104
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2217406
LAB Type Pharmacy
Facility Name WALGREENS #11966
Street 180 COLEMANS XING
City MARYSVILLE
State OH
ZIP 43040
Phone 937 578-0156
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 KEVIN S. HAMMOND

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