14D2015162 CLIA NUMBER - WALGREENS # 04409

Laboratory Demographics

  • CLIA Code: 14D2015162
  • Facility Name: WALGREENS # 04409
  • Facility Address: 1713 W SPRINGFIELD AVE
    CHAMPAIGN, IL
    ZIP 61821
  • Facility Phone: 217 356-2529
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: REGINA OKOLO
  • NPI Number: 1689689705
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2015162
LAB Type Pharmacy
Facility Name WALGREENS # 04409
Street 1713 W SPRINGFIELD AVE
City CHAMPAIGN
State IL
ZIP 61821
Phone 217 356-2529
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2025
Certificate Expiration Date 3/21/2027
Facility Type Pharmacy
Lab Director REGINA OKOLO

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