14D1094979 CLIA NUMBER - WALGREENS #02492

Laboratory Demographics

  • CLIA Code: 14D1094979
  • Facility Name: WALGREENS #02492
  • Facility Address: 3216 E CLEAR LAKE AVE
    SPRINGFIELD, IL
    ZIP 62702
  • Facility Phone: 217 544-7948
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KAYLA M. TOMCZYK
  • NPI Number: 1629084181
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1094979
LAB Type Pharmacy
Facility Name WALGREENS #02492
Street 3216 E CLEAR LAKE AVE
City SPRINGFIELD
State IL
ZIP 62702
Phone 217 544-7948
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/19/2025
Certificate Expiration Date 4/18/2027
Facility Type Pharmacy
Lab Director KAYLA M. TOMCZYK

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