15D2037732 CLIA NUMBER - WALGREENS 04190

Laboratory Demographics

  • CLIA Code: 15D2037732
  • Facility Name: WALGREENS 04190
  • Facility Address: 6730 BLUFFTON RD
    FORT WAYNE, IN
    ZIP 46809
  • Facility Phone: 260 747-7563
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALLISON N. WILSON
  • NPI Number: 1851306971
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2037732
LAB Type Pharmacy
Facility Name WALGREENS 04190
Street 6730 BLUFFTON RD
City FORT WAYNE
State IN
ZIP 46809
Phone 260 747-7563
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/18/2025
Certificate Expiration Date 9/17/2027
Facility Type Pharmacy
Lab Director ALLISON N. WILSON

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