15D2011016 CLIA NUMBER - WALGREENS #05803

Laboratory Demographics

  • CLIA Code: 15D2011016
  • Facility Name: WALGREENS #05803
  • Facility Address: 2720 W JACKSON ST
    MUNCIE, IN
    ZIP 47303
  • Facility Phone: 765 287-8533
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHINTHIDA N. KETHDY
  • NPI Number: 1306851449
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 15D2011016
LAB Type Pharmacy
Facility Name WALGREENS #05803
Street 2720 W JACKSON ST
City MUNCIE
State IN
ZIP 47303
Phone 765 287-8533
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 CHINTHIDA N. KETHDY

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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