15D1021043 CLIA NUMBER - WALGREENS #05241

Laboratory Demographics

CLIA Number: 15D1021043

Facility Name: WALGREENS #05241

Facility Address:
252 MORTHLAND DRIVE
VALPARAISO, IN
ZIP 46383
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Facility Phone Number: 219 464-9776

Facility Type: Other - COVID TESTING

Certificate Type: Waiver

NPI Number: 1104833193

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	15D1021043
LAB Type	Other - COVID TESTING
Facility Name	WALGREENS #05241
Street	252 MORTHLAND DRIVE
City	VALPARAISO
State	IN
ZIP	46383
Phone	219 464-9776
CertificateType	4
CertificateEffectiveDate	2/16/2023
CertificateExpirationDate	2/15/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024