15D1077777 CLIA NUMBER - SCOTTS PHARMACY #412

Laboratory Demographics

  • CLIA Code: 15D1077777
  • Facility Name: SCOTTS PHARMACY #412
  • Facility Address: 1125 W STATE
    FORT WAYNE, IN
    ZIP 46808
  • Facility Phone: 260 426-4487
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RON MILLER
  • NPI Number: 1689879074
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1077777
LAB Type Pharmacy
Facility Name SCOTTS PHARMACY #412
Street 1125 W STATE
City FORT WAYNE
State IN
ZIP 46808
Phone 260 426-4487
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/19/2023
Certificate Expiration Date 12/18/2025
Facility Type Pharmacy
Lab Director RON MILLER

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