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14D2051383 CLIA NUMBER - WALGREENS #03136

Laboratory Demographics

CLIA Number: 14D2051383

Facility Name: WALGREENS #03136

Facility Address:
1201 CAMP JACKSON RD
CAHOKIA, IL
ZIP 62206
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Facility Phone Number: 847 527-4238

Facility Type: Other - COVID-19 TEST SITE

Certificate Type: Waiver
NPI Number: 1609881861

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 14D2051383
LAB Type Other - COVID-19 TEST SITE
Facility Name WALGREENS #03136
Street 1201 CAMP JACKSON RD
City CAHOKIA
State IL
ZIP 62206
Phone 847 527-4238
CertificateType 4
CertificateEffectiveDate 4/21/2024
CertificateExpirationDate 4/20/2026
FacilityType Waiver

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