15D2219452 CLIA NUMBER - WALGREENS #12074

Laboratory Demographics

  • CLIA Code: 15D2219452
  • Facility Name: WALGREENS #12074
  • Facility Address: 308 N MAIN ST
    HEBRON, IN
    ZIP 46341
  • Facility Phone: 219 996-2930
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JILL A. MORETH
  • NPI Number: 1578578696
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2219452
LAB Type Pharmacy
Facility Name WALGREENS #12074
Street 308 N MAIN ST
City HEBRON
State IN
ZIP 46341
Phone 219 996-2930
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/6/2025
Certificate Expiration Date 4/5/2027
Facility Type Pharmacy
Lab Director JILL A. MORETH

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