15D2041937 CLIA NUMBER - CUSTOM PLUS PHARMACY LLC

Laboratory Demographics

  • CLIA Code: 15D2041937
  • Facility Name: CUSTOM PLUS PHARMACY LLC
  • Facility Address: 482 W NAVAJO, STE A
    WEST LAFAYETTE, IN
    ZIP 47906
  • Facility Phone: 765 463-2600
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BENJAMIN M. RACHWAL
  • NPI Number: 1477813970
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2041937
LAB Type Pharmacy
Facility Name CUSTOM PLUS PHARMACY LLC
Street 482 W NAVAJO, STE A
City WEST LAFAYETTE
State IN
ZIP 47906
Phone 765 463-2600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/1/2024
Certificate Expiration Date 5/31/2026
Facility Type Pharmacy
Lab Director BENJAMIN M. RACHWAL

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