14D1097207 CLIA NUMBER - WALGREENS #05602

Laboratory Demographics

  • CLIA Code: 14D1097207
  • Facility Name: WALGREENS #05602
  • Facility Address: 134 W MORTON AVE
    JACKSONVILLE, IL
    ZIP 62650
  • Facility Phone: 217 243-7818
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DELLA D. LEINBERGER
  • NPI Number: 1073528204
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1097207
LAB Type Pharmacy
Facility Name WALGREENS #05602
Street 134 W MORTON AVE
City JACKSONVILLE
State IL
ZIP 62650
Phone 217 243-7818
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2025
Certificate Expiration Date 3/21/2027
Facility Type Pharmacy
Lab Director DELLA D. LEINBERGER

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