15D2011016 CLIA NUMBER - WALGREENS #05803

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Laboratory Demographics

CLIA Number: 15D2011016

Facility Name: WALGREENS #05803

Facility Address:
2720 W JACKSON ST
MUNCIE, IN
ZIP 47303
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Facility Phone Number: 765 287-8533

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1306851449

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	15D2011016
LAB Type	Pharmacy
Facility Name	WALGREENS #05803
Street	2720 W JACKSON ST
City	MUNCIE
State	IN
ZIP	47303
Phone	765 287-8533
CertificateType	4
CertificateEffectiveDate	4/9/2023
CertificateExpirationDate	4/8/2025
FacilityType	Waiver

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