14D2213991 CLIA NUMBER - WALGREENS #04277

Laboratory Demographics

CLIA Number: 14D2213991

Facility Name: WALGREENS #04277

Facility Address:
602 W LIBERTY STREET
WAUCONDA, IL
ZIP 60084
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Facility Phone Number: 847 487-9383

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1518972785

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	14D2213991
LAB Type	Pharmacy
Facility Name	WALGREENS #04277
Street	602 W LIBERTY STREET
City	WAUCONDA
State	IL
ZIP	60084
Phone	847 487-9383
CertificateType	4
CertificateEffectiveDate	2/18/2023
CertificateExpirationDate	2/17/2025
FacilityType	Waiver

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