14D2037859 CLIA NUMBER - WALGREENS 15166

Laboratory Demographics

  • CLIA Code: 14D2037859
  • Facility Name: WALGREENS 15166
  • Facility Address: 108 N MARKET ST
    MONTICELLO, IL
    ZIP 61856
  • Facility Phone: 217 762-2056
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MAEN QATOUM
  • NPI Number: 1427340462
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2037859
LAB Type Pharmacy
Facility Name WALGREENS 15166
Street 108 N MARKET ST
City MONTICELLO
State IL
ZIP 61856
Phone 217 762-2056
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/10/2025
Certificate Expiration Date 10/9/2027
Facility Type Pharmacy
Lab Director MAEN QATOUM

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