14D1094700 CLIA NUMBER - WALGREENS #03901

Laboratory Demographics

  • CLIA Code: 14D1094700
  • Facility Name: WALGREENS #03901
  • Facility Address: 2945 S 6TH ST
    SPRINGFIELD, IL
    ZIP 62703
  • Facility Phone: 217 788-5846
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TEENA M. HALTERMAN
  • NPI Number: 1144235300
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1094700
LAB Type Pharmacy
Facility Name WALGREENS #03901
Street 2945 S 6TH ST
City SPRINGFIELD
State IL
ZIP 62703
Phone 217 788-5846
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 TEENA M. HALTERMAN

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