15D2206295 CLIA NUMBER - WALGREENS #11795

Laboratory Demographics

  • CLIA Code: 15D2206295
  • Facility Name: WALGREENS #11795
  • Facility Address: 3551 CASSAPOLIS STREET
    ELKHART, IN
    ZIP 46514
  • Facility Phone: 574 206-0285
  • Facility Type: Other - COVID 19 TEST SITE
  • Facility Type: Waiver
  • Lab Director: MELISSA HURST
  • NPI Number: 1043485568
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2206295
LAB Type Other - COVID 19 TEST SITE
Facility Name WALGREENS #11795
Street 3551 CASSAPOLIS STREET
City ELKHART
State IN
ZIP 46514
Phone 574 206-0285
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/18/2024
Certificate Expiration Date 12/17/2026
Facility Type Other - COVID 19 TEST SITE
Lab Director MELISSA HURST

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