14D2037881 CLIA NUMBER - WALGREENS #09824

Laboratory Demographics

  • CLIA Code: 14D2037881
  • Facility Name: WALGREENS #09824
  • Facility Address: 705 S STATE ST
    JERSEYVILLE, IL
    ZIP 62052
  • Facility Phone: 618 498-4989
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DANIELLE E. KANALLAKAN
  • NPI Number: 1104847375
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2037881
LAB Type Pharmacy
Facility Name WALGREENS #09824
Street 705 S STATE ST
City JERSEYVILLE
State IL
ZIP 62052
Phone 618 498-4989
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2025
Certificate Expiration Date 3/21/2027
Facility Type Pharmacy
Lab Director DANIELLE E. KANALLAKAN

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