14D2015160 CLIA NUMBER - WALGREENS #04407

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Laboratory Demographics

CLIA Number: 14D2015160

Facility Name: WALGREENS #04407

Facility Address:
3732 NAMEOKI RD
GRANITE CITY, IL
ZIP 62040
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Facility Phone Number: 618 877-6880

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1215942511

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	14D2015160
LAB Type	Pharmacy
Facility Name	WALGREENS #04407
Street	3732 NAMEOKI RD
City	GRANITE CITY
State	IL
ZIP	62040
Phone	618 877-6880
CertificateType	4
CertificateEffectiveDate	10/22/2023
CertificateExpirationDate	10/21/2025
FacilityType	Waiver

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