14D2235392 CLIA NUMBER - WALGREENS #06002

Laboratory Demographics

CLIA Number: 14D2235392

Facility Name: WALGREENS #06002

Facility Address:
1201 E STATE ST
ROCKFORD, IL
ZIP 61104
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Facility Phone Number: 815 962-2812

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1104107796

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	14D2235392
LAB Type	Pharmacy
Facility Name	WALGREENS #06002
Street	1201 E STATE ST
City	ROCKFORD
State	IL
ZIP	61104
Phone	815 962-2812
CertificateType	4
CertificateEffectiveDate	9/9/2023
CertificateExpirationDate	9/8/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024