15D1008312 CLIA NUMBER - MEIJER PHARMACY 125

Laboratory Demographics

  • CLIA Code: 15D1008312
  • Facility Name: MEIJER PHARMACY 125
  • Facility Address: 5909 ILLINOIS RD
    FORT WAYNE, IN
    ZIP 46804
  • Facility Phone: 260 434-3910
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JACQUELINE MORSE
  • NPI Number: 1841560646
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1008312
LAB Type Pharmacy
Facility Name MEIJER PHARMACY 125
Street 5909 ILLINOIS RD
City FORT WAYNE
State IN
ZIP 46804
Phone 260 434-3910
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/16/2025
Certificate Expiration Date 1/15/2027
Facility Type Pharmacy
Lab Director JACQUELINE MORSE

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