15D1008319 CLIA NUMBER - MEIJER PHARMACY 120

Laboratory Demographics

  • CLIA Code: 15D1008319
  • Facility Name: MEIJER PHARMACY 120
  • Facility Address: 3600 N PORTAGE RD
    SOUTH BEND, IN
    ZIP 46628
  • Facility Phone: 574 273-3410
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JACQUELINE MORSE
  • NPI Number: 1033489844
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 15D1008319
LAB Type Pharmacy
Facility Name MEIJER PHARMACY 120
Street 3600 N PORTAGE RD
City SOUTH BEND
State IN
ZIP 46628
Phone 574 273-3410
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

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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