14D2207136 CLIA NUMBER - WALGREENS #10885

Laboratory Demographics

  • CLIA Code: 14D2207136
  • Facility Name: WALGREENS #10885
  • Facility Address: 2091 ORCHARD RD
    MONTGOMERY, IL
    ZIP 60538
  • Facility Phone: 630 801-6977
  • Facility Type: Other - COVID 19 TESTING SITE
  • Facility Type: Waiver
  • Lab Director: JEFFERY S. FAWVER
  • NPI Number: 1235397068
  • Taxonomy: 333600000X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/23/2024
Certificate Expiration Date 12/22/2026
Facility Type Other - COVID 19 TESTING SITE
Lab Director JEFFERY S. FAWVER

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