14D1077750 CLIA NUMBER - HY-VEE PHARMACY #1420

Laboratory Demographics

  • CLIA Code: 14D1077750
  • Facility Name: HY-VEE PHARMACY #1420
  • Facility Address: 1600 E JACKSON
    MACOMB, IL
    ZIP 61455
  • Facility Phone: 309 833-3750
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANDREA R. THOMPSON
  • NPI Number: 1679502462
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1077750
LAB Type Pharmacy
Facility Name HY-VEE PHARMACY #1420
Street 1600 E JACKSON
City MACOMB
State IL
ZIP 61455
Phone 309 833-3750
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/18/2023
Certificate Expiration Date 12/17/2025
Facility Type Pharmacy
Lab Director ANDREA R. THOMPSON

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