14D2285887 CLIA NUMBER - CVS/PHARMACY #02692 HIGHLAND PARK CVS, LLC

Laboratory Demographics

  • CLIA Code: 14D2285887
  • Facility Name: CVS/PHARMACY #02692 HIGHLAND PARK CVS, LLC
  • Facility Address: 936 S MAIN ST
    JACKSONVILLE, IL
    ZIP 62650
  • Facility Phone: 217 243-1728
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TRACY FLANAGAN
  • NPI Number: 1497993232
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2285887
LAB Type Pharmacy
Facility Name CVS/PHARMACY #02692 HIGHLAND PARK CVS, LLC
Street 936 S MAIN ST
City JACKSONVILLE
State IL
ZIP 62650
Phone 217 243-1728
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/19/2025
Certificate Expiration Date 7/18/2027
Facility Type Pharmacy
Lab Director TRACY FLANAGAN

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