15D2067706 CLIA NUMBER - WALGREENS #09482

Laboratory Demographics

  • CLIA Code: 15D2067706
  • Facility Name: WALGREENS #09482
  • Facility Address: 110 E MCKINLEY AVE
    MISHAWAKA, IN
    ZIP 46545
  • Facility Phone: 574 255-9677
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ELLIOT R. ANDERSON
  • NPI Number: 1922013051
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 15D2067706
LAB Type Pharmacy
Facility Name WALGREENS #09482
Street 110 E MCKINLEY AVE
City MISHAWAKA
State IN
ZIP 46545
Phone 574 255-9677
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/11/2025
Certificate Expiration Date 5/10/2027
Facility Type Pharmacy
Lab Director ELLIOT R. ANDERSON

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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