14D2216383 CLIA NUMBER - WALGREENS #12583

Laboratory Demographics

  • CLIA Code: 14D2216383
  • Facility Name: WALGREENS #12583
  • Facility Address: 1704 E RIVERSIDE BLVD
    LOVES PARK, IL
    ZIP 61111
  • Facility Phone: (815) 633-0475
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RANDI D. DOTSETH
  • NPI Number: 1033368618
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2216383
LAB Type Pharmacy
Facility Name WALGREENS #12583
Street 1704 E RIVERSIDE BLVD
City LOVES PARK
State IL
ZIP 61111
Phone 8156330475
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 RANDI D. DOTSETH

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This page was last updated on: 5/18/2026