15D2018610 CLIA NUMBER - WALGREENS #11085

Laboratory Demographics

  • CLIA Code: 15D2018610
  • Facility Name: WALGREENS #11085
  • Facility Address: 52482 INDIANA STATE ROUTE 933
    SOUTH BEND, IN
    ZIP 46637
  • Facility Phone: 574 271-0357
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LARRY B. TAYLOR
  • NPI Number: 1033124169
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2018610
LAB Type Pharmacy
Facility Name WALGREENS #11085
Street 52482 INDIANA STATE ROUTE 933
City SOUTH BEND
State IN
ZIP 46637
Phone 574 271-0357
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/15/2025
Certificate Expiration Date 4/14/2027
Facility Type Pharmacy
Lab Director LARRY B. TAYLOR

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