14D2013931 CLIA NUMBER - WALGREENS # 05088

Laboratory Demographics

  • CLIA Code: 14D2013931
  • Facility Name: WALGREENS # 05088
  • Facility Address: 300 N MAIN ST
    EAST PEORIA, IL
    ZIP 61611
  • Facility Phone: 309 694-7661
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RYAN L. SANGALLI
  • NPI Number: 1447265624
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2013931
LAB Type Pharmacy
Facility Name WALGREENS # 05088
Street 300 N MAIN ST
City EAST PEORIA
State IL
ZIP 61611
Phone 309 694-7661
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/25/2025
Certificate Expiration Date 3/24/2027
Facility Type Pharmacy
Lab Director RYAN L. SANGALLI

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