14D2015154 CLIA NUMBER - WALGREENS #04179

Laboratory Demographics

  • CLIA Code: 14D2015154
  • Facility Name: WALGREENS #04179
  • Facility Address: 2100 W STATE ST
    GENEVA, IL
    ZIP 60134
  • Facility Phone: 630 262-0970
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOSADEC L. CERRATO
  • NPI Number: 1992710115
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2015154
LAB Type Pharmacy
Facility Name WALGREENS #04179
Street 2100 W STATE ST
City GENEVA
State IL
ZIP 60134
Phone 630 262-0970
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/22/2025
Certificate Expiration Date 6/21/2027
Facility Type Pharmacy
Lab Director JOSADEC L. CERRATO

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