15D2182692 CLIA NUMBER - PURDUE UNIVERSITY PHARMACY

Laboratory Demographics

  • CLIA Code: 15D2182692
  • Facility Name: PURDUE UNIVERSITY PHARMACY
  • Facility Address: 575 STADIUM MALL DRIVE, ROOM 118
    WEST LAFAYETTE, IN
    ZIP 47907
  • Facility Phone: 765 494-1374
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TREXIE RUDD
  • NPI Number: 1053512004
  • Taxonomy: 122300000X - Dentist

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 15D2182692
LAB Type Pharmacy
Facility Name PURDUE UNIVERSITY PHARMACY
Street 575 STADIUM MALL DRIVE, ROOM 118
City WEST LAFAYETTE
State IN
ZIP 47907
Phone 765 494-1374
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/24/2024
Certificate Expiration Date 4/23/2026
Facility Type Pharmacy
Lab Director TREXIE RUDD

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