15D2127975 CLIA NUMBER - WALMART PHARMACY #10-2678

Laboratory Demographics

  • CLIA Code: 15D2127975
  • Facility Name: WALMART PHARMACY #10-2678
  • Facility Address: 316 INDIAN RIDGE BLVD
    MISHAWAKA, IN
    ZIP 46545
  • Facility Phone: 574 243-9707
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHARLES GAW
  • NPI Number: 1922025147
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 15D2127975
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-2678
Street 316 INDIAN RIDGE BLVD
City MISHAWAKA
State IN
ZIP 46545
Phone 574 243-9707
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2025
Certificate Expiration Date 3/21/2027
Facility Type Pharmacy
Lab Director CHARLES GAW

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