15D2011532 CLIA NUMBER - WALGREENS #13949

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Laboratory Demographics

CLIA Number: 15D2011532

Facility Name: WALGREENS #13949

Facility Address:
6001 CENTRAL
PORTAGE, IN
ZIP 46368
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Facility Phone Number: 219 762-8030

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1023023140

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	15D2011532
LAB Type	Pharmacy
Facility Name	WALGREENS #13949
Street	6001 CENTRAL
City	PORTAGE
State	IN
ZIP	46368
Phone	219 762-8030
CertificateType	4
CertificateEffectiveDate	5/13/2023
CertificateExpirationDate	5/12/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024