15D2011012 CLIA NUMBER - WALGREENS #05115

Laboratory Demographics

  • CLIA Code: 15D2011012
  • Facility Name: WALGREENS #05115
  • Facility Address: 10412 COLDWATER RD
    FORT WAYNE, IN
    ZIP 46845
  • Facility Phone: 260 637-0848
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LAURA M. REED
  • NPI Number: 1225043367
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2011012
LAB Type Pharmacy
Facility Name WALGREENS #05115
Street 10412 COLDWATER RD
City FORT WAYNE
State IN
ZIP 46845
Phone 260 637-0848
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/12/2025
Certificate Expiration Date 5/11/2027
Facility Type Pharmacy
Lab Director LAURA M. REED

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