14D2019077 CLIA NUMBER - WALGREENS # 11829

Laboratory Demographics

  • CLIA Code: 14D2019077
  • Facility Name: WALGREENS # 11829
  • Facility Address: 2500 S KOKE MILL RD
    SPRINGFIELD, IL
    ZIP 62711
  • Facility Phone: 217 726-0979
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KRISTINA L. NAGEL
  • NPI Number: 1407039159
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D2019077
LAB Type Pharmacy
Facility Name WALGREENS # 11829
Street 2500 S KOKE MILL RD
City SPRINGFIELD
State IL
ZIP 62711
Phone 217 726-0979
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/24/2025
Certificate Expiration Date 3/23/2027
Facility Type Pharmacy
Lab Director KRISTINA L. NAGEL

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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