14D2015288 CLIA NUMBER - WALGREENS #09921

Laboratory Demographics

  • CLIA Code: 14D2015288
  • Facility Name: WALGREENS #09921
  • Facility Address: 1509 S NEIL ST
    CHAMPAIGN, IL
    ZIP 61820
  • Facility Phone: 217 351-1516
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANDREW MACAITIS
  • NPI Number: 1134139090
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2015288
LAB Type Pharmacy
Facility Name WALGREENS #09921
Street 1509 S NEIL ST
City CHAMPAIGN
State IL
ZIP 61820
Phone 217 351-1516
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/1/2023
Certificate Expiration Date 10/31/2025
Facility Type Pharmacy
Lab Director ANDREW MACAITIS

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