15D2039885 CLIA NUMBER - WALGREENS #02796

Laboratory Demographics

  • CLIA Code: 15D2039885
  • Facility Name: WALGREENS #02796
  • Facility Address: 3003 KESSLER BLVD N DR
    INDIANAPOLIS, IN
    ZIP 46222
  • Facility Phone: 317 414-7396
  • Facility Type: Other - COVID-19 TEST SITE
  • Facility Type: Waiver
  • Lab Director: STEVAN MIZIMAKOSKI
  • NPI Number: 1538176524
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2039885
LAB Type Other - COVID-19 TEST SITE
Facility Name WALGREENS #02796
Street 3003 KESSLER BLVD N DR
City INDIANAPOLIS
State IN
ZIP 46222
Phone 317 414-7396
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/11/2024
Certificate Expiration Date 8/10/2026
Facility Type Other - COVID-19 TEST SITE
Lab Director STEVAN MIZIMAKOSKI

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