14D2034845 CLIA NUMBER - WALGREENS #02876

Laboratory Demographics

  • CLIA Code: 14D2034845
  • Facility Name: WALGREENS #02876
  • Facility Address: 3001 BROADWAY ST
    MOUNT VERNON, IL
    ZIP 62864
  • Facility Phone: 618 242-1442
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHERITY HAMILTON
  • NPI Number: 1053326207
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D2034845
LAB Type Pharmacy
Facility Name WALGREENS #02876
Street 3001 BROADWAY ST
City MOUNT VERNON
State IL
ZIP 62864
Phone 618 242-1442
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/2/2023
Certificate Expiration Date 11/1/2025
Facility Type Pharmacy
Lab Director CHERITY HAMILTON

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