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14D2090415 CLIA NUMBER - ILLINOIS CANCERCARE - BLOOMINGTON

Laboratory Demographics

CLIA Number: 14D2090415

Facility Name: ILLINOIS CANCERCARE - BLOOMINGTON

Facility Address:
3105 MAGORY DR
BLOOMINGTON, IL
ZIP 61704
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Facility Phone Number: 309 243-3000

Facility Type: Physician Office

Certificate Type: Certificate of Compliance
NPI Number: 1740662949

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name Field Value
CLIA Number 14D2090415
LAB Type Physician Office
Facility Name ILLINOIS CANCERCARE - BLOOMINGTON
Street 3105 MAGORY DR
City BLOOMINGTON
State IL
ZIP 61704
Phone 309 243-3000
CertificateType 2
CertificateEffectiveDate 5/27/2021
CertificateExpirationDate 4/30/2024
FacilityType Compliance

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This page was last updated on: 4/23/2024