15D2011482 CLIA NUMBER - WALGREENS #06456

Laboratory Demographics

  • CLIA Code: 15D2011482
  • Facility Name: WALGREENS #06456
  • Facility Address: 1000 SAGAMORE PKWY W
    WEST LAFAYETTE, IN
    ZIP 47906
  • Facility Phone: 765 497-2300
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DANIEL G. FORSYTHE
  • NPI Number: 1982619029
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2011482
LAB Type Pharmacy
Facility Name WALGREENS #06456
Street 1000 SAGAMORE PKWY W
City WEST LAFAYETTE
State IN
ZIP 47906
Phone 765 497-2300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/19/2025
Certificate Expiration Date 3/18/2027
Facility Type Pharmacy
Lab Director DANIEL G. FORSYTHE

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