14D2216374 CLIA NUMBER - WALGREENS #07769

Laboratory Demographics

  • CLIA Code: 14D2216374
  • Facility Name: WALGREENS #07769
  • Facility Address: 7880 WINN RD
    SPRING GROVE, IL
    ZIP 60081
  • Facility Phone: 815 675-2408
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: VIVIAN M. KASAL
  • NPI Number: 1164704524
  • Taxonomy: 261QC1500X - Clinic/Center

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/11/2025
Certificate Expiration Date 3/10/2027
Facility Type Pharmacy
Lab Director VIVIAN M. KASAL

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