15D2067765 CLIA NUMBER - WALGREENS #06965

Laboratory Demographics

  • CLIA Code: 15D2067765
  • Facility Name: WALGREENS #06965
  • Facility Address: 15005 STATE ROAD 23
    GRANGER, IN
    ZIP 46530
  • Facility Phone: 574 271-2553
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LUCINDA M. TUCKER
  • NPI Number: 1063427102
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2067765
LAB Type Pharmacy
Facility Name WALGREENS #06965
Street 15005 STATE ROAD 23
City GRANGER
State IN
ZIP 46530
Phone 574 271-2553
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/20/2025
Certificate Expiration Date 7/19/2027
Facility Type Pharmacy
Lab Director LUCINDA M. TUCKER

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