14D2216374 CLIA NUMBER - WALGREENS #07769

Laboratory Demographics

CLIA Number: 14D2216374

Facility Name: WALGREENS #07769

Facility Address:
7880 WINN RD
SPRING GROVE, IL
ZIP 60081
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Facility Phone Number: 815 675-2408

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1164704524

Taxonomy: 261QC1500X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2216374
LAB Type	Pharmacy
Facility Name	WALGREENS #07769
Street	7880 WINN RD
City	SPRING GROVE
State	IL
ZIP	60081
Phone	815 675-2408
CertificateType	4
CertificateEffectiveDate	3/11/2023
CertificateExpirationDate	3/10/2025
FacilityType	Waiver

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