14D1093984 CLIA NUMBER - WALGREENS #09792

Laboratory Demographics

  • CLIA Code: 14D1093984
  • Facility Name: WALGREENS #09792
  • Facility Address: 625 W PERSHING RD
    DECATUR, IL
    ZIP 62526
  • Facility Phone: 217 875-2751
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ELIZABETH LONG
  • NPI Number: 1922013226
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1093984
LAB Type Pharmacy
Facility Name WALGREENS #09792
Street 625 W PERSHING RD
City DECATUR
State IL
ZIP 62526
Phone 217 875-2751
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/2/2025
Certificate Expiration Date 4/1/2027
Facility Type Pharmacy
Lab Director ELIZABETH LONG

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