15D2011025 CLIA NUMBER - WALGREENS #09290

Laboratory Demographics

  • CLIA Code: 15D2011025
  • Facility Name: WALGREENS #09290
  • Facility Address: 2500 GRANT ST
    GARY, IN
    ZIP 46404
  • Facility Phone: 219 949-1055
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JERMEL GOLSTON
  • NPI Number: 1023023157
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2011025
LAB Type Pharmacy
Facility Name WALGREENS #09290
Street 2500 GRANT ST
City GARY
State IN
ZIP 46404
Phone 219 949-1055
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/13/2025
Certificate Expiration Date 5/12/2027
Facility Type Pharmacy
Lab Director JERMEL GOLSTON

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