14D2051408 CLIA NUMBER - WALGREENS 04602

Laboratory Demographics

  • CLIA Code: 14D2051408
  • Facility Name: WALGREENS 04602
  • Facility Address: 2510 STATE ST
    E ST LOUIS, IL
    ZIP 62205
  • Facility Phone: 618 875-5085
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEFFREY T. FIELDS
  • NPI Number: 1174538359
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2051408
LAB Type Pharmacy
Facility Name WALGREENS 04602
Street 2510 STATE ST
City E ST LOUIS
State IL
ZIP 62205
Phone 618 875-5085
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/5/2024
Certificate Expiration Date 3/4/2026
Facility Type Pharmacy
Lab Director JEFFREY T. FIELDS

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