15D2010992 CLIA NUMBER - WALGREENS #04668

Laboratory Demographics

  • CLIA Code: 15D2010992
  • Facility Name: WALGREENS #04668
  • Facility Address: 1003 N MAIN ST
    CROWN POINT, IN
    ZIP 46307
  • Facility Phone: 219 663-6669
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MIRA DAMNJANOVIC
  • NPI Number: 1306851423
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2010992
LAB Type Pharmacy
Facility Name WALGREENS #04668
Street 1003 N MAIN ST
City CROWN POINT
State IN
ZIP 46307
Phone 219 663-6669
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/9/2025
Certificate Expiration Date 4/8/2027
Facility Type Pharmacy
Lab Director MIRA DAMNJANOVIC

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