15D2030274 CLIA NUMBER - WALGREENS #11454

Laboratory Demographics

  • CLIA Code: 15D2030274
  • Facility Name: WALGREENS #11454
  • Facility Address: 319 E TIPTON ST
    SEYMOUR, IN
    ZIP 47274
  • Facility Phone: 812 522-0620
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DALE J. ISAACS
  • NPI Number: 1366623605
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2030274
LAB Type Pharmacy
Facility Name WALGREENS #11454
Street 319 E TIPTON ST
City SEYMOUR
State IN
ZIP 47274
Phone 812 522-0620
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 DALE J. ISAACS

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