15D2027390 CLIA NUMBER - WALGREENS #04276

Laboratory Demographics

  • CLIA Code: 15D2027390
  • Facility Name: WALGREENS #04276
  • Facility Address: 9280 WICKER AVE
    ST JOHN, IN
    ZIP 46373
  • Facility Phone: 219 365-9847
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ELEFTHERIA KOTSIS
  • NPI Number: 1407861545
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2027390
LAB Type Pharmacy
Facility Name WALGREENS #04276
Street 9280 WICKER AVE
City ST JOHN
State IN
ZIP 46373
Phone 219 365-9847
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/18/2025
Certificate Expiration Date 5/17/2027
Facility Type Pharmacy
Lab Director ELEFTHERIA KOTSIS

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