15D2206192 CLIA NUMBER - WALGREENS #11544

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Laboratory Demographics

CLIA Number: 15D2206192

Facility Name: WALGREENS #11544

Facility Address:
13060 ADAMS RD
GRANGER, IN
ZIP 46530
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Facility Phone Number: 574 243-5468

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1336311752

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	15D2206192
LAB Type	Pharmacy
Facility Name	WALGREENS #11544
Street	13060 ADAMS RD
City	GRANGER
State	IN
ZIP	46530
Phone	574 243-5468
CertificateType	4
CertificateEffectiveDate	12/17/2022
CertificateExpirationDate	12/16/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024