15D1077743 CLIA NUMBER - SCOTTS PHARMACY J-407

Laboratory Demographics

  • CLIA Code: 15D1077743
  • Facility Name: SCOTTS PHARMACY J-407
  • Facility Address: 929 S 13TH ST
    DECATUR, IN
    ZIP 46733
  • Facility Phone: 260 724-9187
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANTHONY MUNDT
  • NPI Number: 1659576049
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1077743
LAB Type Pharmacy
Facility Name SCOTTS PHARMACY J-407
Street 929 S 13TH ST
City DECATUR
State IN
ZIP 46733
Phone 260 724-9187
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/18/2023
Certificate Expiration Date 12/17/2025
Facility Type Pharmacy
Lab Director ANTHONY MUNDT

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