36D2222947 CLIA NUMBER - WALGREENS #05821

Laboratory Demographics

  • CLIA Code: 36D2222947
  • Facility Name: WALGREENS #05821
  • Facility Address: 132 RICHMOD ST
    PAINESVILLE, OH
    ZIP 44077
  • Facility Phone: 440 350-1928
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRANDON BOURGEOIS
  • NPI Number: 1225043250
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2222947
LAB Type Pharmacy
Facility Name WALGREENS #05821
Street 132 RICHMOD ST
City PAINESVILLE
State OH
ZIP 44077
Phone 440 350-1928
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/3/2025
Certificate Expiration Date 5/2/2027
Facility Type Pharmacy
Lab Director BRANDON BOURGEOIS

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This page was last updated on: 6/4/2025