14D2217287 CLIA NUMBER - WALGREENS #04777

Laboratory Demographics

  • CLIA Code: 14D2217287
  • Facility Name: WALGREENS #04777
  • Facility Address: 2525 S ALPINE RD
    ROCKFORD, IL
    ZIP 61108
  • Facility Phone: 815 227-9861
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GLENN CARGUILLO
  • NPI Number: 1093720294
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2217287
LAB Type Pharmacy
Facility Name WALGREENS #04777
Street 2525 S ALPINE RD
City ROCKFORD
State IL
ZIP 61108
Phone 815 227-9861
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/19/2025
Certificate Expiration Date 3/18/2027
Facility Type Pharmacy
Lab Director GLENN CARGUILLO

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