14D2217312 CLIA NUMBER - WALGREENS #12555

Laboratory Demographics

  • CLIA Code: 14D2217312
  • Facility Name: WALGREENS #12555
  • Facility Address: 2404 S PERRYVILLE RD
    ROCKFORD, IL
    ZIP 61108
  • Facility Phone: 815 332-3256
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SYWIA WRONKA
  • NPI Number: 1376785667
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2217312
LAB Type Pharmacy
Facility Name WALGREENS #12555
Street 2404 S PERRYVILLE RD
City ROCKFORD
State IL
ZIP 61108
Phone 815 332-3256
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 SYWIA WRONKA

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