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14D2207136 CLIA NUMBER - WALGREENS #10885

Laboratory Demographics

CLIA Number: 14D2207136

Facility Name: WALGREENS #10885

Facility Address:
2091 ORCHARD RD
MONTGOMERY, IL
ZIP 60538
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Facility Phone Number: 630 801-6977

Facility Type: Other - COVID 19 TESTING SITE

Certificate Type: Waiver
NPI Number: 1235397068

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name Field Value
CLIA Number 14D2207136
LAB Type Other - COVID 19 TESTING SITE
Facility Name WALGREENS #10885
Street 2091 ORCHARD RD
City MONTGOMERY
State IL
ZIP 60538
Phone 630 801-6977
CertificateType 4
CertificateEffectiveDate 12/23/2022
CertificateExpirationDate 12/22/2024
FacilityType Waiver

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