15D2239562 CLIA NUMBER - WALGREENS #04560

Laboratory Demographics

  • CLIA Code: 15D2239562
  • Facility Name: WALGREENS #04560
  • Facility Address: 5995 US HIGHWAY 6
    PORTAGE, IN
    ZIP 46368
  • Facility Phone: 219 762-2134
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GINA S. BENDER
  • NPI Number: 1922015916
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2239562
LAB Type Pharmacy
Facility Name WALGREENS #04560
Street 5995 US HIGHWAY 6
City PORTAGE
State IN
ZIP 46368
Phone 219 762-2134
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/13/2025
Certificate Expiration Date 10/12/2027
Facility Type Pharmacy
Lab Director GINA S. BENDER

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