15D2010999 CLIA NUMBER - WALGREENS #05452

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Laboratory Demographics

CLIA Number: 15D2010999

Facility Name: WALGREENS #05452

Facility Address:
2410 N COLISEUM BLVD
FORT WAYNE, IN
ZIP 46805
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Facility Phone Number: 260 483-5612

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1467467571

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	15D2010999
LAB Type	Pharmacy
Facility Name	WALGREENS #05452
Street	2410 N COLISEUM BLVD
City	FORT WAYNE
State	IN
ZIP	46805
Phone	260 483-5612
CertificateType	4
CertificateEffectiveDate	5/14/2023
CertificateExpirationDate	5/13/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024