14D1033228 CLIA NUMBER - OSCO DRUG #0063

Laboratory Demographics

  • CLIA Code: 14D1033228
  • Facility Name: OSCO DRUG #0063
  • Facility Address: 763 E 162ND ST
    SOUTH HOLLAND, IL
    ZIP 60473
  • Facility Phone: 708 339-0453
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RACHEL RUSSELL
  • NPI Number: 1558317479
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1033228
LAB Type Pharmacy
Facility Name OSCO DRUG #0063
Street 763 E 162ND ST
City SOUTH HOLLAND
State IL
ZIP 60473
Phone 708 339-0453
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/5/2024
Certificate Expiration Date 11/4/2026
Facility Type Pharmacy
Lab Director RACHEL RUSSELL

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