15D2038410 CLIA NUMBER - WALGREENS #09793

Laboratory Demographics

  • CLIA Code: 15D2038410
  • Facility Name: WALGREENS #09793
  • Facility Address: 5435 E DUPONT RD
    FORT WAYNE, IN
    ZIP 46825
  • Facility Phone: 260 482-1653
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LORI L. GRESSMAN
  • NPI Number: 1215066493
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2038410
LAB Type Pharmacy
Facility Name WALGREENS #09793
Street 5435 E DUPONT RD
City FORT WAYNE
State IN
ZIP 46825
Phone 260 482-1653
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/12/2025
Certificate Expiration Date 10/11/2027
Facility Type Pharmacy
Lab Director LORI L. GRESSMAN

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