14D2058668 CLIA NUMBER - WALGREENS #09267

Laboratory Demographics

  • CLIA Code: 14D2058668
  • Facility Name: WALGREENS #09267
  • Facility Address: 440 10TH AVE W
    MILAN, IL
    ZIP 61264
  • Facility Phone: 309 787-2161
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SUSI B. WONG
  • NPI Number: 1114932225
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2058668
LAB Type Pharmacy
Facility Name WALGREENS #09267
Street 440 10TH AVE W
City MILAN
State IL
ZIP 61264
Phone 309 787-2161
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/8/2025
Certificate Expiration Date 4/7/2027
Facility Type Pharmacy
Lab Director SUSI B. WONG

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