14D2027148 CLIA NUMBER - WALGREENS # 09922

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Laboratory Demographics

CLIA Number: 14D2027148

Facility Name: WALGREENS # 09922

Facility Address:
4 S COMMERCIAL ST
HARRISBURG, IL
ZIP 62946
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Facility Phone Number: 618 252-0134

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1598948622

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	14D2027148
LAB Type	Pharmacy
Facility Name	WALGREENS # 09922
Street	4 S COMMERCIAL ST
City	HARRISBURG
State	IL
ZIP	62946
Phone	618 252-0134
CertificateType	4
CertificateEffectiveDate	3/30/2023
CertificateExpirationDate	3/29/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024