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15D2219452 CLIA NUMBER - WALGREENS #12074

Laboratory Demographics

CLIA Number: 15D2219452

Facility Name: WALGREENS #12074

Facility Address:
308 N MAIN ST
HEBRON, IN
ZIP 46341
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Facility Phone Number: 219 996-2930

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1578578696

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 15D2219452
LAB Type Pharmacy
Facility Name WALGREENS #12074
Street 308 N MAIN ST
City HEBRON
State IN
ZIP 46341
Phone 219 996-2930
CertificateType 4
CertificateEffectiveDate 4/6/2023
CertificateExpirationDate 4/5/2025
FacilityType Waiver

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