15D2037710 CLIA NUMBER - WALGREENS #10073

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Laboratory Demographics

CLIA Number: 15D2037710

Facility Name: WALGREENS #10073

Facility Address:
2400 W SYCAMORE ST
KOKOMO, IN
ZIP 46901
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Facility Phone Number: 847 527-4238

Facility Type: Other - COVID-19 TEST SITE

Certificate Type: Waiver

NPI Number: 1356497002

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	15D2037710
LAB Type	Other - COVID-19 TEST SITE
Facility Name	WALGREENS #10073
Street	2400 W SYCAMORE ST
City	KOKOMO
State	IN
ZIP	46901
Phone	847 527-4238
CertificateType	4
CertificateEffectiveDate	5/18/2022
CertificateExpirationDate	5/17/2024
FacilityType	Waiver

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