14D2015155 CLIA NUMBER - WALGREENS # 04219

Laboratory Demographics

  • CLIA Code: 14D2015155
  • Facility Name: WALGREENS # 04219
  • Facility Address: 206 S WALL ST
    CARBONDALE, IL
    ZIP 62901
  • Facility Phone: 618 457-4104
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JULIA N. BOST
  • NPI Number: 1528073665
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2015155
LAB Type Pharmacy
Facility Name WALGREENS # 04219
Street 206 S WALL ST
City CARBONDALE
State IL
ZIP 62901
Phone 618 457-4104
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/7/2025
Certificate Expiration Date 4/6/2027
Facility Type Pharmacy
Lab Director JULIA N. BOST

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