14D1094507 CLIA NUMBER - WALGREENS #05719

Laboratory Demographics

  • CLIA Code: 14D1094507
  • Facility Name: WALGREENS #05719
  • Facility Address: 4995 E U S ROUTE 36
    DECATUR, IL
    ZIP 62521
  • Facility Phone: 217 864-9866
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GARY C. CALHOUN JR
  • NPI Number: 1114932415
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1094507
LAB Type Pharmacy
Facility Name WALGREENS #05719
Street 4995 E U S ROUTE 36
City DECATUR
State IL
ZIP 62521
Phone 217 864-9866
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/13/2025
Certificate Expiration Date 4/12/2027
Facility Type Pharmacy
Lab Director GARY C. CALHOUN JR

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