15D2018767 CLIA NUMBER - WALGREENS #10720

Laboratory Demographics

  • CLIA Code: 15D2018767
  • Facility Name: WALGREENS #10720
  • Facility Address: 129 CLIFTY DR
    MADISON, IN
    ZIP 47250
  • Facility Phone: 812 273-5840
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KELLY J. FERGUSON
  • NPI Number: 1780875955
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2018767
LAB Type Pharmacy
Facility Name WALGREENS #10720
Street 129 CLIFTY DR
City MADISON
State IN
ZIP 47250
Phone 812 273-5840
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 KELLY J. FERGUSON

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