15D2191639 CLIA NUMBER - WALGREENS #11625

Laboratory Demographics

  • CLIA Code: 15D2191639
  • Facility Name: WALGREENS #11625
  • Facility Address: 4620 LINCOLNWAY E
    MISHAWAKA, IN
    ZIP 46544
  • Facility Phone: 574 257-0438
  • Facility Type: Other - COVID- 19 TEST SITE
  • Facility Type: Waiver
  • Lab Director: BENJAMIN M. BRINGEDAHL
  • NPI Number: 1881831147
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 15D2191639
LAB Type Other - COVID- 19 TEST SITE
Facility Name WALGREENS #11625
Street 4620 LINCOLNWAY E
City MISHAWAKA
State IN
ZIP 46544
Phone 574 257-0438
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/31/2024
Certificate Expiration Date 8/30/2026
Facility Type Other - COVID- 19 TEST SITE
Lab Director BENJAMIN M. BRINGEDAHL

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