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14D2216380 CLIA NUMBER - WALGREENS #12287

Laboratory Demographics

CLIA Number: 14D2216380

Facility Name: WALGREENS #12287

Facility Address:
1732 S WEST AVE
FREEPORT, IL
ZIP 61032
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Facility Phone Number: 815 235-8148

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1174761381

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 14D2216380
LAB Type Pharmacy
Facility Name WALGREENS #12287
Street 1732 S WEST AVE
City FREEPORT
State IL
ZIP 61032
Phone 815 235-8148
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