36D2287400 CLIA NUMBER - WALGREENS 04639

Laboratory Demographics

  • CLIA Code: 36D2287400
  • Facility Name: WALGREENS 04639
  • Facility Address: 4497 FAR HILLS AVE
    KETTERING, OH
    ZIP 45429
  • Facility Phone: 937 396-1358
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RACHEL VAN MATRE
  • NPI Number: 1598770521
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2287400
LAB Type Pharmacy
Facility Name WALGREENS 04639
Street 4497 FAR HILLS AVE
City KETTERING
State OH
ZIP 45429
Phone 937 396-1358
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/14/2025
Certificate Expiration Date 8/13/2027
Facility Type Pharmacy
Lab Director RACHEL VAN MATRE

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