15D2217265 CLIA NUMBER - WALGREENS #04486

Laboratory Demographics

CLIA Number: 15D2217265

Facility Name: WALGREENS #04486

Facility Address:
5520 US HIGHWAY 30
SCHERERVILLE, IN
ZIP 46375
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Facility Phone Number: 219 864-1476

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1255347688

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	15D2217265
LAB Type	Pharmacy
Facility Name	WALGREENS #04486
Street	5520 US HIGHWAY 30
City	SCHERERVILLE
State	IN
ZIP	46375
Phone	219 864-1476
CertificateType	4
CertificateEffectiveDate	3/19/2023
CertificateExpirationDate	3/18/2025
FacilityType	Waiver

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