14D2015212 CLIA NUMBER - WALGREENS #05188

Laboratory Demographics

  • CLIA Code: 14D2015212
  • Facility Name: WALGREENS #05188
  • Facility Address: 1525 N VETERANS PKWY
    BLOOMINGTON, IL
    ZIP 61704
  • Facility Phone: 309 661-8613
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STEPHANIE K. SCOLARO
  • NPI Number: 1265447445
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2015212
LAB Type Pharmacy
Facility Name WALGREENS #05188
Street 1525 N VETERANS PKWY
City BLOOMINGTON
State IL
ZIP 61704
Phone 309 661-8613
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/30/2025
Certificate Expiration Date 4/29/2027
Facility Type Pharmacy
Lab Director STEPHANIE K. SCOLARO

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