14D2037848 CLIA NUMBER - WALGREENS #12744

Laboratory Demographics

  • CLIA Code: 14D2037848
  • Facility Name: WALGREENS #12744
  • Facility Address: 108 S POPLAR ST
    PANA, IL
    ZIP 62557
  • Facility Phone: 217 562-2770
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BAILEY J. MILTENBERGER
  • NPI Number: 1003041674
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2037848
LAB Type Pharmacy
Facility Name WALGREENS #12744
Street 108 S POPLAR ST
City PANA
State IL
ZIP 62557
Phone 217 562-2770
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/30/2025
Certificate Expiration Date 3/29/2027
Facility Type Pharmacy
Lab Director BAILEY J. MILTENBERGER

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