14D2038308 CLIA NUMBER - WALGREENS #03907

Laboratory Demographics

  • CLIA Code: 14D2038308
  • Facility Name: WALGREENS #03907
  • Facility Address: 2532 N ILLINOIS ST
    SWANSEA, IL
    ZIP 62226
  • Facility Phone: 618 236-3928
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOHN E. KOCKA
  • NPI Number: 1548276025
  • Taxonomy: 333600000X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/11/2025
Certificate Expiration Date 5/10/2027
Facility Type Pharmacy
Lab Director JOHN E. KOCKA

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