15D2025044 CLIA NUMBER - WALGREENS #09100

Laboratory Demographics

  • CLIA Code: 15D2025044
  • Facility Name: WALGREENS #09100
  • Facility Address: 2014 N MICHIGAN ST
    PLYMOUTH, IN
    ZIP 46563
  • Facility Phone: 574 936-8388
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STACEY L. HOLDERREAD
  • NPI Number: 1417962564
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2025044
LAB Type Pharmacy
Facility Name WALGREENS #09100
Street 2014 N MICHIGAN ST
City PLYMOUTH
State IN
ZIP 46563
Phone 574 936-8388
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 STACEY L. HOLDERREAD

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This page was last updated on: 6/4/2025