14D2027122 CLIA NUMBER - WALGREENS # 03763

Laboratory Demographics

  • CLIA Code: 14D2027122
  • Facility Name: WALGREENS # 03763
  • Facility Address: 1011 PEORIA ST
    WASHINGTON, IL
    ZIP 61571
  • Facility Phone: 309 444-1681
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHRISTOPHER A. JACOBSEN
  • NPI Number: 1205841319
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2027122
LAB Type Pharmacy
Facility Name WALGREENS # 03763
Street 1011 PEORIA ST
City WASHINGTON
State IL
ZIP 61571
Phone 309 444-1681
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 CHRISTOPHER A. JACOBSEN

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