14D1032736 CLIA NUMBER - OSCO DRUG #4013

Laboratory Demographics

  • CLIA Code: 14D1032736
  • Facility Name: OSCO DRUG #4013
  • Facility Address: 1200 W BOUGHTON RD
    BOLINGBROOK, IL
    ZIP 60440
  • Facility Phone: 630 759-1362
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RACHEL RUSSELL
  • NPI Number: 1952357485
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1032736
LAB Type Pharmacy
Facility Name OSCO DRUG #4013
Street 1200 W BOUGHTON RD
City BOLINGBROOK
State IL
ZIP 60440
Phone 630 759-1362
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/28/2024
Certificate Expiration Date 10/27/2026
Facility Type Pharmacy
Lab Director RACHEL RUSSELL

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