14D2037845 CLIA NUMBER - WALGREENS #04599

Laboratory Demographics

  • CLIA Code: 14D2037845
  • Facility Name: WALGREENS #04599
  • Facility Address: 704 CAMBRIDGE BLVD
    O FALLON, IL
    ZIP 62269
  • Facility Phone: 618 632-6920
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMANDA K. RANDAZZO
  • NPI Number: 1508871773
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2037845
LAB Type Pharmacy
Facility Name WALGREENS #04599
Street 704 CAMBRIDGE BLVD
City O FALLON
State IL
ZIP 62269
Phone 618 632-6920
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/11/2025
Certificate Expiration Date 5/10/2027
Facility Type Pharmacy
Lab Director AMANDA K. RANDAZZO

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