14D2047198 CLIA NUMBER - WALGREENS #13921

Laboratory Demographics

  • CLIA Code: 14D2047198
  • Facility Name: WALGREENS #13921
  • Facility Address: 420 W 1ST DR
    DECATUR, IL
    ZIP 62523
  • Facility Phone: 217 422-3801
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANDREW L. HARTMAN
  • NPI Number: 1225307986
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2047198
LAB Type Pharmacy
Facility Name WALGREENS #13921
Street 420 W 1ST DR
City DECATUR
State IL
ZIP 62523
Phone 217 422-3801
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/23/2025
Certificate Expiration Date 3/22/2027
Facility Type Pharmacy
Lab Director ANDREW L. HARTMAN

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