14D2235122 CLIA NUMBER - PRINCEVILLE PHARMACY

Laboratory Demographics

  • CLIA Code: 14D2235122
  • Facility Name: PRINCEVILLE PHARMACY
  • Facility Address: 206 E MAIN ST
    PRINCEVILLE, IL
    ZIP 61559
  • Facility Phone: 309 385-4955
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KEVIN W. FRYE
  • NPI Number: 1750455127
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2235122
LAB Type Pharmacy
Facility Name PRINCEVILLE PHARMACY
Street 206 E MAIN ST
City PRINCEVILLE
State IL
ZIP 61559
Phone 309 385-4955
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/7/2025
Certificate Expiration Date 9/6/2027
Facility Type Pharmacy
Lab Director KEVIN W. FRYE

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