36D2279440 CLIA NUMBER - OHIO CVS STORES, LLC CVS/PHARMACY #03420

Laboratory Demographics

  • CLIA Code: 36D2279440
  • Facility Name: OHIO CVS STORES, LLC CVS/PHARMACY #03420
  • Facility Address: 1410 E DOROTHY LN
    KETTERING, OH
    ZIP 45429
  • Facility Phone: 937 294-9535
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JUNHONG HAN
  • NPI Number: 1457454274
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2279440
LAB Type Physician Office
Facility Name OHIO CVS STORES, LLC CVS/PHARMACY #03420
Street 1410 E DOROTHY LN
City KETTERING
State OH
ZIP 45429
Phone 937 294-9535
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/3/2025
Certificate Expiration Date 4/2/2027
Facility Type Physician Office
Lab Director JUNHONG HAN

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