14D2058665 CLIA NUMBER - WALGREENS #04332

Laboratory Demographics

  • CLIA Code: 14D2058665
  • Facility Name: WALGREENS #04332
  • Facility Address: 2955 18TH AVE
    ROCK ISLAND, IL
    ZIP 61201
  • Facility Phone: 309 786-4362
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KELLI PAULSON
  • NPI Number: 1275549750
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2058665
LAB Type Pharmacy
Facility Name WALGREENS #04332
Street 2955 18TH AVE
City ROCK ISLAND
State IL
ZIP 61201
Phone 309 786-4362
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 KELLI PAULSON

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