14D2195996 CLIA NUMBER - ILLINI CLINIC PHARMACY ILLINI CLINIC PHARMACY, INC

Laboratory Demographics

  • CLIA Code: 14D2195996
  • Facility Name: ILLINI CLINIC PHARMACY ILLINI CLINIC PHARMACY, INC
  • Facility Address: 855 ILLINI DR - STE 200
    SILVIS, IL
    ZIP 61282
  • Facility Phone: 309 792-7002
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEFF R. MERIDETH
  • NPI Number: 1356561039
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2195996
LAB Type Pharmacy
Facility Name ILLINI CLINIC PHARMACY ILLINI CLINIC PHARMACY, INC
Street 855 ILLINI DR - STE 200
City SILVIS
State IL
ZIP 61282
Phone 309 792-7002
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/14/2024
Certificate Expiration Date 10/13/2026
Facility Type Pharmacy
Lab Director JEFF R. MERIDETH

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