14D2058662 CLIA NUMBER - WALGREENS #02591

Laboratory Demographics

  • CLIA Code: 14D2058662
  • Facility Name: WALGREENS #02591
  • Facility Address: 1275 N GALENA AVE
    DIXON, IL
    ZIP 61021
  • Facility Phone: 815 288-7844
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CASEY CONWAY
  • NPI Number: 1467467761
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2058662
LAB Type Pharmacy
Facility Name WALGREENS #02591
Street 1275 N GALENA AVE
City DIXON
State IL
ZIP 61021
Phone 815 288-7844
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/9/2025
Certificate Expiration Date 4/8/2027
Facility Type Pharmacy
Lab Director CASEY CONWAY

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