14D2216770 CLIA NUMBER - WALGREENS #12126

Laboratory Demographics

  • CLIA Code: 14D2216770
  • Facility Name: WALGREENS #12126
  • Facility Address: 1680 W LANE RD
    MACHESNEY PARK, IL
    ZIP 61115
  • Facility Phone: 815 282-1203
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRANDON M. BROWN
  • NPI Number: 1336302512
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D2216770
LAB Type Pharmacy
Facility Name WALGREENS #12126
Street 1680 W LANE RD
City MACHESNEY PARK
State IL
ZIP 61115
Phone 815 282-1203
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/16/2025
Certificate Expiration Date 3/15/2027
Facility Type Pharmacy
Lab Director BRANDON M. BROWN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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