14D2049171 CLIA NUMBER - WALGREENS #06004

Laboratory Demographics

  • CLIA Code: 14D2049171
  • Facility Name: WALGREENS #06004
  • Facility Address: 3929 N MULFORD RD
    ROCKFORD, IL
    ZIP 61114
  • Facility Phone: 815 633-9157
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ADEBOLA U. EROGBOGBO
  • NPI Number: 1659386860
  • Taxonomy: 333600000X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/11/2025
Certificate Expiration Date 3/10/2027
Facility Type Pharmacy
Lab Director ADEBOLA U. EROGBOGBO

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