15D2011435 CLIA NUMBER - WALGREENS #05978

Laboratory Demographics

  • CLIA Code: 15D2011435
  • Facility Name: WALGREENS #05978
  • Facility Address: 11020 PENDLETON PIKE
    INDIANAPOLIS, IN
    ZIP 46236
  • Facility Phone: 317 826-3903
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DEREU L. STREETER
  • NPI Number: 1124035126
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2011435
LAB Type Pharmacy
Facility Name WALGREENS #05978
Street 11020 PENDLETON PIKE
City INDIANAPOLIS
State IN
ZIP 46236
Phone 317 826-3903
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/20/2025
Certificate Expiration Date 7/19/2027
Facility Type Pharmacy
Lab Director DEREU L. STREETER

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