14D2054558 CLIA NUMBER - WALGREENS #09313

Laboratory Demographics

  • CLIA Code: 14D2054558
  • Facility Name: WALGREENS #09313
  • Facility Address: 1502 FORT JESSE RD
    NORMAL, IL
    ZIP 61761
  • Facility Phone: 309 862-4156
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JESSICA HELTON
  • NPI Number: 1396750402
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2054558
LAB Type Pharmacy
Facility Name WALGREENS #09313
Street 1502 FORT JESSE RD
City NORMAL
State IL
ZIP 61761
Phone 309 862-4156
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/19/2025
Certificate Expiration Date 3/18/2027
Facility Type Pharmacy
Lab Director JESSICA HELTON

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