14D2037827 CLIA NUMBER - WALGREENS #12504

Laboratory Demographics

  • CLIA Code: 14D2037827
  • Facility Name: WALGREENS #12504
  • Facility Address: 110 W 10TH ST
    METROPOLIS, IL
    ZIP 62960
  • Facility Phone: 618 524-4819
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KELSEY M. ROBERTSON
  • NPI Number: 1356579338
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2037827
LAB Type Pharmacy
Facility Name WALGREENS #12504
Street 110 W 10TH ST
City METROPOLIS
State IL
ZIP 62960
Phone 618 524-4819
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/8/2025
Certificate Expiration Date 4/7/2027
Facility Type Pharmacy
Lab Director KELSEY M. ROBERTSON

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