14D2054565 CLIA NUMBER - WALGREENS #11828

Laboratory Demographics

  • CLIA Code: 14D2054565
  • Facility Name: WALGREENS #11828
  • Facility Address: 909 S MAIN ST
    BLOOMINGTON, IL
    ZIP 61701
  • Facility Phone: 309 829-1540
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LISA E. WINGATE
  • NPI Number: 1922256825
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2054565
LAB Type Pharmacy
Facility Name WALGREENS #11828
Street 909 S MAIN ST
City BLOOMINGTON
State IL
ZIP 61701
Phone 309 829-1540
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/24/2025
Certificate Expiration Date 3/23/2027
Facility Type Pharmacy
Lab Director LISA E. WINGATE

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