15D1008317 CLIA NUMBER - MEIJER PHARMACY 121

Laboratory Demographics

  • CLIA Code: 15D1008317
  • Facility Name: MEIJER PHARMACY 121
  • Facility Address: 5020 GRAPE RD
    MISHAWAKA, IN
    ZIP 46545
  • Facility Phone: 574 273-3510
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JACQUELINE MORSE
  • NPI Number: 1932479730
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1008317
LAB Type Pharmacy
Facility Name MEIJER PHARMACY 121
Street 5020 GRAPE RD
City MISHAWAKA
State IN
ZIP 46545
Phone 574 273-3510
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