36D2231541 CLIA NUMBER - WALGREENS #04983

Laboratory Demographics

  • CLIA Code: 36D2231541
  • Facility Name: WALGREENS #04983
  • Facility Address: 4024 FULTON DR NW
    CANTON, OH
    ZIP 44718
  • Facility Phone: 330 493-8431
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAY KOCESKI
  • NPI Number: 1235144254
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2231541
LAB Type Pharmacy
Facility Name WALGREENS #04983
Street 4024 FULTON DR NW
City CANTON
State OH
ZIP 44718
Phone 330 493-8431
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/4/2025
Certificate Expiration Date 8/3/2027
Facility Type Pharmacy
Lab Director JAY KOCESKI

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