15D2239628 CLIA NUMBER - WALGREENS #04946

Laboratory Demographics

  • CLIA Code: 15D2239628
  • Facility Name: WALGREENS #04946
  • Facility Address: 580 INDIAN BOUNDARY RD
    CHESTERTON, IN
    ZIP 46304
  • Facility Phone: 219 395-8583
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAMIE C. LUCIO
  • NPI Number: 1134134273
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2239628
LAB Type Pharmacy
Facility Name WALGREENS #04946
Street 580 INDIAN BOUNDARY RD
City CHESTERTON
State IN
ZIP 46304
Phone 219 395-8583
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 JAMIE C. LUCIO

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