15D2067705 CLIA NUMBER - WALGREENS #12264

Laboratory Demographics

  • CLIA Code: 15D2067705
  • Facility Name: WALGREENS #12264
  • Facility Address: 200 S NAPPANEE ST
    ELKHART, IN
    ZIP 46514
  • Facility Phone: 574 293-2063
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STACY W. CLARK
  • NPI Number: 1447498662
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2067705
LAB Type Pharmacy
Facility Name WALGREENS #12264
Street 200 S NAPPANEE ST
City ELKHART
State IN
ZIP 46514
Phone 574 293-2063
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/6/2025
Certificate Expiration Date 4/5/2027
Facility Type Pharmacy
Lab Director STACY W. CLARK

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