15D2037693 CLIA NUMBER - WALGREENS #09853

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Laboratory Demographics

CLIA Number: 15D2037693

Facility Name: WALGREENS #09853

Facility Address:
10170 MAYSVILLE RD
FORT WAYNE, IN
ZIP 46835
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Facility Phone Number: 260 486-7295

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1588694368

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	15D2037693
LAB Type	Pharmacy
Facility Name	WALGREENS #09853
Street	10170 MAYSVILLE RD
City	FORT WAYNE
State	IN
ZIP	46835
Phone	260 486-7295
CertificateType	4
CertificateEffectiveDate	4/9/2023
CertificateExpirationDate	4/8/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024