14D2049171 CLIA NUMBER - WALGREENS #06004

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Laboratory Demographics

CLIA Number: 14D2049171

Facility Name: WALGREENS #06004

Facility Address:
3929 N MULFORD RD
ROCKFORD, IL
ZIP 61114
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Facility Phone Number: 815 633-9157

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1659386860

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	14D2049171
LAB Type	Pharmacy
Facility Name	WALGREENS #06004
Street	3929 N MULFORD RD
City	ROCKFORD
State	IL
ZIP	61114
Phone	815 633-9157
CertificateType	4
CertificateEffectiveDate	3/11/2023
CertificateExpirationDate	3/10/2025
FacilityType	Waiver

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