14D2054558 CLIA NUMBER - WALGREENS #09313

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Laboratory Demographics

CLIA Number: 14D2054558

Facility Name: WALGREENS #09313

Facility Address:
1502 FORT JESSE RD
NORMAL, IL
ZIP 61761
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Facility Phone Number: 309 862-4156

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1396750402

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	14D2054558
LAB Type	Pharmacy
Facility Name	WALGREENS #09313
Street	1502 FORT JESSE RD
City	NORMAL
State	IL
ZIP	61761
Phone	309 862-4156
CertificateType	4
CertificateEffectiveDate	3/19/2023
CertificateExpirationDate	3/18/2025
FacilityType	Waiver

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