15D2011456 CLIA NUMBER - WALGREENS #10124

Laboratory Demographics

  • CLIA Code: 15D2011456
  • Facility Name: WALGREENS #10124
  • Facility Address: 1400 CASSOPOLIS ST
    ELKHART, IN
    ZIP 46514
  • Facility Phone: 574 262-2756
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DYLON C. GREGG
  • NPI Number: 1205841335
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 15D2011456
LAB Type Pharmacy
Facility Name WALGREENS #10124
Street 1400 CASSOPOLIS ST
City ELKHART
State IN
ZIP 46514
Phone 574 262-2756
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/9/2025
Certificate Expiration Date 4/8/2027
Facility Type Pharmacy
Lab Director DYLON C. GREGG

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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