15D2037754 CLIA NUMBER - WALGREENS #09827

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Laboratory Demographics

CLIA Number: 15D2037754

Facility Name: WALGREENS #09827

Facility Address:
720 N BROADWAY
PERU, IN
ZIP 46970
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Facility Phone Number: 765 473-5542

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1205841327

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	15D2037754
LAB Type	Pharmacy
Facility Name	WALGREENS #09827
Street	720 N BROADWAY
City	PERU
State	IN
ZIP	46970
Phone	765 473-5542
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