15D1077742 CLIA NUMBER - SCOTTS PHARMACY J405

Laboratory Demographics

  • CLIA Code: 15D1077742
  • Facility Name: SCOTTS PHARMACY J405
  • Facility Address: 4120 N CLINTON ST
    FT WAYNE, IN
    ZIP 46805
  • Facility Phone: (260) 483-3185
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEYDA D. GRUEL-FIELDS
  • NPI Number: 1790989879
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1077742
LAB Type Pharmacy
Facility Name SCOTTS PHARMACY J405
Street 4120 N CLINTON ST
City FT WAYNE
State IN
ZIP 46805
Phone 2604833185
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/18/2025
Certificate Expiration Date 12/17/2027
Facility Type Pharmacy
Lab Director JEYDA D. GRUEL-FIELDS

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This page was last updated on: 5/18/2026