15D2071474 CLIA NUMBER - WALGREENS #12640

Laboratory Demographics

  • CLIA Code: 15D2071474
  • Facility Name: WALGREENS #12640
  • Facility Address: 226 N HALLECK ST
    DEMOTTE, IN
    ZIP 46310
  • Facility Phone: 219 987-4900
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DAVID SCHWIMMER
  • NPI Number: 1225266109
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2071474
LAB Type Pharmacy
Facility Name WALGREENS #12640
Street 226 N HALLECK ST
City DEMOTTE
State IN
ZIP 46310
Phone 219 987-4900
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 DAVID SCHWIMMER

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