14D2051406 CLIA NUMBER - WALGREENS 04971

Laboratory Demographics

  • CLIA Code: 14D2051406
  • Facility Name: WALGREENS 04971
  • Facility Address: 2001 MADISON AVE
    GRANITE CITY, IL
    ZIP 62040
  • Facility Phone: 618 876-5095
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRENT A. ASHER
  • NPI Number: 1235146317
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2051406
LAB Type Pharmacy
Facility Name WALGREENS 04971
Street 2001 MADISON AVE
City GRANITE CITY
State IL
ZIP 62040
Phone 618 876-5095
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/24/2025
Certificate Expiration Date 8/23/2027
Facility Type Pharmacy
Lab Director BRENT A. ASHER

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