36D2224185 CLIA NUMBER - WALGREENS #04975

Laboratory Demographics

  • CLIA Code: 36D2224185
  • Facility Name: WALGREENS #04975
  • Facility Address: 1542 WAYNE AVE
    DAYTON, OH
    ZIP 45410
  • Facility Phone: 937 254-2156
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CEDRICK D. PARKS
  • NPI Number: 1326053349
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 36D2224185
LAB Type Pharmacy
Facility Name WALGREENS #04975
Street 1542 WAYNE AVE
City DAYTON
State OH
ZIP 45410
Phone 937 254-2156
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/12/2025
Certificate Expiration Date 5/11/2027
Facility Type Pharmacy
Lab Director CEDRICK D. PARKS

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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