15D1021043 CLIA NUMBER - WALGREENS #05241

Laboratory Demographics

  • CLIA Code: 15D1021043
  • Facility Name: WALGREENS #05241
  • Facility Address: 252 MORTHLAND DR
    VALPARAISO, IN
    ZIP 46383
  • Facility Phone: 219 464-9776
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MITCHELL HERZOG
  • NPI Number: 1104833193
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1021043
LAB Type Pharmacy
Facility Name WALGREENS #05241
Street 252 MORTHLAND DR
City VALPARAISO
State IN
ZIP 46383
Phone 219 464-9776
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/16/2025
Certificate Expiration Date 2/15/2027
Facility Type Pharmacy
Lab Director MITCHELL HERZOG

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