15D2011480 CLIA NUMBER - WALGREENS #12788

Laboratory Demographics

  • CLIA Code: 15D2011480
  • Facility Name: WALGREENS #12788
  • Facility Address: 407 W GLEN PARK AVE
    GRIFFITH, IN
    ZIP 46319
  • Facility Phone: 219 924-2701
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOSEPH M. HEJL
  • NPI Number: 1578570560
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2011480
LAB Type Pharmacy
Facility Name WALGREENS #12788
Street 407 W GLEN PARK AVE
City GRIFFITH
State IN
ZIP 46319
Phone 219 924-2701
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/21/2025
Certificate Expiration Date 4/20/2027
Facility Type Pharmacy
Lab Director JOSEPH M. HEJL

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