15D2037754 CLIA NUMBER - WALGREENS #09827

Laboratory Demographics

  • CLIA Code: 15D2037754
  • Facility Name: WALGREENS #09827
  • Facility Address: 720 N BROADWAY
    PERU, IN
    ZIP 46970
  • Facility Phone: 765 473-5542
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: THOMAS P. MAST
  • NPI Number: 1205841327
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2037754
LAB Type Pharmacy
Facility Name WALGREENS #09827
Street 720 N BROADWAY
City PERU
State IN
ZIP 46970
Phone 765 473-5542
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 THOMAS P. MAST

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