14D2056823 CLIA NUMBER - WALGREENS #04042

Laboratory Demographics

  • CLIA Code: 14D2056823
  • Facility Name: WALGREENS #04042
  • Facility Address: 100 W LINCOLN HWY
    DEKALB, IL
    ZIP 60115
  • Facility Phone: 815 756-1815
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PERRI ROCHE
  • NPI Number: 1255346425
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2056823
LAB Type Pharmacy
Facility Name WALGREENS #04042
Street 100 W LINCOLN HWY
City DEKALB
State IL
ZIP 60115
Phone 815 756-1815
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/13/2025
Certificate Expiration Date 4/12/2027
Facility Type Pharmacy
Lab Director PERRI ROCHE

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