15D2068598 CLIA NUMBER - WALGREENS #05194

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Laboratory Demographics

CLIA Number: 15D2068598

Facility Name: WALGREENS #05194

Facility Address:
1704 E COMMERCIAL AVE
LOWELL, IN
ZIP 46356
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Facility Phone Number: 219 696-6638

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1750396875

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	15D2068598
LAB Type	Pharmacy
Facility Name	WALGREENS #05194
Street	1704 E COMMERCIAL AVE
City	LOWELL
State	IN
ZIP	46356
Phone	219 696-6638
CertificateType	4
CertificateEffectiveDate	4/9/2023
CertificateExpirationDate	4/8/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024