14D2019079 CLIA NUMBER - WALGREENS #02206

Laboratory Demographics

  • CLIA Code: 14D2019079
  • Facility Name: WALGREENS #02206
  • Facility Address: 300 E JACKSON ST
    MACOMB, IL
    ZIP 61455
  • Facility Phone: 309 837-2436
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CRYSTAL D. WHITE
  • NPI Number: 1245245406
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2019079
LAB Type Pharmacy
Facility Name WALGREENS #02206
Street 300 E JACKSON ST
City MACOMB
State IL
ZIP 61455
Phone 309 837-2436
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 CRYSTAL D. WHITE

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