14D2014556 CLIA NUMBER - WALGREENS # 15164

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Laboratory Demographics

CLIA Number: 14D2014556

Facility Name: WALGREENS # 15164

Facility Address:
2611 E OAKLAND AVE
BLOOMINGTON, IL
ZIP 61701
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Facility Phone Number: 309 663-8344

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1861407983

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	14D2014556
LAB Type	Pharmacy
Facility Name	WALGREENS # 15164
Street	2611 E OAKLAND AVE
City	BLOOMINGTON
State	IL
ZIP	61701
Phone	309 663-8344
CertificateType	4
CertificateEffectiveDate	3/24/2023
CertificateExpirationDate	3/23/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024