15D2229642 CLIA NUMBER - WALGREENS #06733

Laboratory Demographics

  • CLIA Code: 15D2229642
  • Facility Name: WALGREENS #06733
  • Facility Address: 3500 CENTRAL AVE
    LAKE STATION, IN
    ZIP 46405
  • Facility Phone: 219 963-7355
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DARREN L. HARTMAN
  • NPI Number: 1518972652
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2229642
LAB Type Pharmacy
Facility Name WALGREENS #06733
Street 3500 CENTRAL AVE
City LAKE STATION
State IN
ZIP 46405
Phone 219 963-7355
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/14/2025
Certificate Expiration Date 7/13/2027
Facility Type Pharmacy
Lab Director DARREN L. HARTMAN

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