14D2069710 CLIA NUMBER - WALGREENS #11367

Laboratory Demographics

  • CLIA Code: 14D2069710
  • Facility Name: WALGREENS #11367
  • Facility Address: 28895 W IL ROUTE 120
    LAKEMOOR, IL
    ZIP 60051
  • Facility Phone: 815 578-9346
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMY M. GARBERDING
  • NPI Number: 1740617984
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2069710
LAB Type Pharmacy
Facility Name WALGREENS #11367
Street 28895 W IL ROUTE 120
City LAKEMOOR
State IL
ZIP 60051
Phone 815 578-9346
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/22/2025
Certificate Expiration Date 6/21/2027
Facility Type Pharmacy
Lab Director AMY M. GARBERDING

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