14D2038308 CLIA NUMBER - WALGREENS #03907

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Laboratory Demographics

CLIA Number: 14D2038308

Facility Name: WALGREENS #03907

Facility Address:
2532 N ILLINOIS ST
SWANSEA, IL
ZIP 62226
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Facility Phone Number: 618 236-3928

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1548276025

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	14D2038308
LAB Type	Pharmacy
Facility Name	WALGREENS #03907
Street	2532 N ILLINOIS ST
City	SWANSEA
State	IL
ZIP	62226
Phone	618 236-3928
CertificateType	4
CertificateEffectiveDate	5/11/2023
CertificateExpirationDate	5/10/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024