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36D2224240 CLIA NUMBER - WALGREENS #04613

Laboratory Demographics

CLIA Number: 36D2224240

Facility Name: WALGREENS #04613

Facility Address:
4855 N MAIN ST
DAYTON, OH
ZIP 45405
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Facility Phone Number: 937 279-0468

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1972518991

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name Field Value
CLIA Number 36D2224240
LAB Type Pharmacy
Facility Name WALGREENS #04613
Street 4855 N MAIN ST
City DAYTON
State OH
ZIP 45405
Phone 937 279-0468
CertificateType 4
CertificateEffectiveDate 5/12/2023
CertificateExpirationDate 5/11/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024