14D1100869 CLIA NUMBER - WALGREENS #05664

Laboratory Demographics

  • CLIA Code: 14D1100869
  • Facility Name: WALGREENS #05664
  • Facility Address: 102 W VANDALIA ST
    EDWARDSVILLE, IL
    ZIP 62025
  • Facility Phone: 618 692-7251
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TAYLOR MAGLASANG
  • NPI Number: 1447265632
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1100869
LAB Type Pharmacy
Facility Name WALGREENS #05664
Street 102 W VANDALIA ST
City EDWARDSVILLE
State IL
ZIP 62025
Phone 618 692-7251
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 TAYLOR MAGLASANG

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