14D2015053 CLIA NUMBER - WALGREENS # 03322

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Laboratory Demographics

CLIA Number: 14D2015053

Facility Name: WALGREENS # 03322

Facility Address:
2323 CHARLES ST
ROCKFORD, IL
ZIP 61104
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Facility Phone Number: 815 399-1474

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1932116969

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	14D2015053
LAB Type	Pharmacy
Facility Name	WALGREENS # 03322
Street	2323 CHARLES ST
City	ROCKFORD
State	IL
ZIP	61104
Phone	815 399-1474
CertificateType	4
CertificateEffectiveDate	3/11/2023
CertificateExpirationDate	3/10/2025
FacilityType	Waiver

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