14D2037876 CLIA NUMBER - WALGREENS #12089

Laboratory Demographics

  • CLIA Code: 14D2037876
  • Facility Name: WALGREENS #12089
  • Facility Address: 1606 S PARK AVE
    HERRIN, IL
    ZIP 62948
  • Facility Phone: 618 942-5291
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BERGANDI R. CARLEY
  • NPI Number: 1366680571
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2037876
LAB Type Pharmacy
Facility Name WALGREENS #12089
Street 1606 S PARK AVE
City HERRIN
State IL
ZIP 62948
Phone 618 942-5291
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/7/2025
Certificate Expiration Date 4/6/2027
Facility Type Pharmacy
Lab Director BERGANDI R. CARLEY

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