14D2037825 CLIA NUMBER - WALGREENS #01996

Laboratory Demographics

  • CLIA Code: 14D2037825
  • Facility Name: WALGREENS #01996
  • Facility Address: 1122 VAUGHN RD
    WOOD RIVER, IL
    ZIP 62095
  • Facility Phone: 618 259-2013
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KERRY STUDNICKI
  • NPI Number: 1043264153
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2037825
LAB Type Pharmacy
Facility Name WALGREENS #01996
Street 1122 VAUGHN RD
City WOOD RIVER
State IL
ZIP 62095
Phone 618 259-2013
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/2/2025
Certificate Expiration Date 3/1/2027
Facility Type Pharmacy
Lab Director KERRY STUDNICKI

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