14D2015232 CLIA NUMBER - WALGREENS #05603

Laboratory Demographics

  • CLIA Code: 14D2015232
  • Facility Name: WALGREENS #05603
  • Facility Address: 1340 DEKALB AVE
    SYCAMORE, IL
    ZIP 60178
  • Facility Phone: 815 895-4609
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JALMINE D. SHAH
  • NPI Number: 1548275738
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2015232
LAB Type Pharmacy
Facility Name WALGREENS #05603
Street 1340 DEKALB AVE
City SYCAMORE
State IL
ZIP 60178
Phone 815 895-4609
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/19/2023
Certificate Expiration Date 11/18/2025
Facility Type Pharmacy
Lab Director JALMINE D. SHAH

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