14D2037873 CLIA NUMBER - WALGREENS #12396

Laboratory Demographics

  • CLIA Code: 14D2037873
  • Facility Name: WALGREENS #12396
  • Facility Address: 505 W RAAB RD
    NORMAL, IL
    ZIP 61761
  • Facility Phone: 309 454-7347
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: COLLEEN A. MOBLEY-BROWN
  • NPI Number: 1235144478
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2037873
LAB Type Pharmacy
Facility Name WALGREENS #12396
Street 505 W RAAB RD
City NORMAL
State IL
ZIP 61761
Phone 309 454-7347
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 COLLEEN A. MOBLEY-BROWN

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