15D2183720 CLIA NUMBER - SHAKAMAK PHARMACY

Laboratory Demographics

  • CLIA Code: 15D2183720
  • Facility Name: SHAKAMAK PHARMACY
  • Facility Address: 346 E MAIN ST
    JASONVILLE, IN
    ZIP 47438
  • Facility Phone: 812 665-9760
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TRAVER WOLF
  • NPI Number: 1477815868
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2183720
LAB Type Pharmacy
Facility Name SHAKAMAK PHARMACY
Street 346 E MAIN ST
City JASONVILLE
State IN
ZIP 47438
Phone 812 665-9760
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/8/2024
Certificate Expiration Date 5/7/2026
Facility Type Pharmacy
Lab Director TRAVER WOLF

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