15D2037693 CLIA NUMBER - WALGREENS #09853

Laboratory Demographics

  • CLIA Code: 15D2037693
  • Facility Name: WALGREENS #09853
  • Facility Address: 10170 MAYSVILLE RD
    FORT WAYNE, IN
    ZIP 46835
  • Facility Phone: 260 486-7295
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LOGAN D. ANDERSON
  • NPI Number: 1588694368
  • Taxonomy: 333600000X - Pharmacy

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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
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 LOGAN D. ANDERSON

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