15D2219274 CLIA NUMBER - WALGREENS #11084

Laboratory Demographics

  • CLIA Code: 15D2219274
  • Facility Name: WALGREENS #11084
  • Facility Address: 1816 FRANKLIN ST
    MICHIGAN CITY, IN
    ZIP 46360
  • Facility Phone: 219 874-2544
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TALITHA AZAROV
  • NPI Number: 1629085618
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2219274
LAB Type Pharmacy
Facility Name WALGREENS #11084
Street 1816 FRANKLIN ST
City MICHIGAN CITY
State IN
ZIP 46360
Phone 219 874-2544
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/5/2025
Certificate Expiration Date 4/4/2027
Facility Type Pharmacy
Lab Director TALITHA AZAROV

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