14D2021352 CLIA NUMBER - WALGREENS #05460

Laboratory Demographics

  • CLIA Code: 14D2021352
  • Facility Name: WALGREENS #05460
  • Facility Address: 1001 W REYNOLDS ST
    PONTIAC, IL
    ZIP 61764
  • Facility Phone: 815 844-4767
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JENNIFER L. NOLAN
  • NPI Number: 1245245422
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2021352
LAB Type Pharmacy
Facility Name WALGREENS #05460
Street 1001 W REYNOLDS ST
City PONTIAC
State IL
ZIP 61764
Phone 815 844-4767
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 JENNIFER L. NOLAN

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