15D2011018 CLIA NUMBER - WALGREENS #06673

Laboratory Demographics

  • CLIA Code: 15D2011018
  • Facility Name: WALGREENS #06673
  • Facility Address: 6202 W JEFFERSON BLVD
    FORT WAYNE, IN
    ZIP 46804
  • Facility Phone: 260 432-5120
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CALEB T. DOXSEE
  • NPI Number: 1245247287
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2011018
LAB Type Pharmacy
Facility Name WALGREENS #06673
Street 6202 W JEFFERSON BLVD
City FORT WAYNE
State IN
ZIP 46804
Phone 260 432-5120
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/12/2025
Certificate Expiration Date 3/11/2027
Facility Type Pharmacy
Lab Director CALEB T. DOXSEE

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