15D2011452 CLIA NUMBER - WALGREENS 03437

Laboratory Demographics

  • CLIA Code: 15D2011452
  • Facility Name: WALGREENS 03437
  • Facility Address: 1010 E IRELAND RD
    SOUTH BEND, IN
    ZIP 46614
  • Facility Phone: 574 299-0154
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JASON M. BURGHOUF
  • NPI Number: 1013922137
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2011452
LAB Type Pharmacy
Facility Name WALGREENS 03437
Street 1010 E IRELAND RD
City SOUTH BEND
State IN
ZIP 46614
Phone 574 299-0154
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/18/2025
Certificate Expiration Date 9/17/2027
Facility Type Pharmacy
Lab Director JASON M. BURGHOUF

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