14D2058669 CLIA NUMBER - WALGREENS #05511

Laboratory Demographics

  • CLIA Code: 14D2058669
  • Facility Name: WALGREENS #05511
  • Facility Address: 500 S MAIN ST
    KEWANEE, IL
    ZIP 61443
  • Facility Phone: 309 853-4412
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SCOTT A. CAMEY
  • NPI Number: 1982619169
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2058669
LAB Type Pharmacy
Facility Name WALGREENS #05511
Street 500 S MAIN ST
City KEWANEE
State IL
ZIP 61443
Phone 309 853-4412
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/25/2025
Certificate Expiration Date 3/24/2027
Facility Type Pharmacy
Lab Director SCOTT A. CAMEY

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