14D2037867 CLIA NUMBER - WALGREENS #09965

Laboratory Demographics

  • CLIA Code: 14D2037867
  • Facility Name: WALGREENS #09965
  • Facility Address: 220 S CENTURY BLVD
    RANTOUL, IL
    ZIP 61866
  • Facility Phone: 217 892-8415
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KATHLEEN M. ROUSE
  • NPI Number: 1306949433
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2037867
LAB Type Pharmacy
Facility Name WALGREENS #09965
Street 220 S CENTURY BLVD
City RANTOUL
State IL
ZIP 61866
Phone 217 892-8415
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/24/2025
Certificate Expiration Date 3/23/2027
Facility Type Pharmacy
Lab Director KATHLEEN M. ROUSE

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