14D2222958 CLIA NUMBER - WALGREENS #11740

Laboratory Demographics

  • CLIA Code: 14D2222958
  • Facility Name: WALGREENS #11740
  • Facility Address: 1212 OGDEN AVE
    MONTGOMERY, IL
    ZIP 60538
  • Facility Phone: 630 820-4098
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JACQUELINE A. JANSEN MAI
  • NPI Number: 1861639767
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2222958
LAB Type Pharmacy
Facility Name WALGREENS #11740
Street 1212 OGDEN AVE
City MONTGOMERY
State IL
ZIP 60538
Phone 630 820-4098
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/3/2025
Certificate Expiration Date 5/2/2027
Facility Type Pharmacy
Lab Director JACQUELINE A. JANSEN MAI

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