14D1034337 CLIA NUMBER - OSCO DRUG #2488

Laboratory Demographics

  • CLIA Code: 14D1034337
  • Facility Name: OSCO DRUG #2488
  • Facility Address: 655 MAIN ST N W
    BOURBONNAIS, IL
    ZIP 60914
  • Facility Phone: 815 929-0590
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RACHEL RUSSELL
  • NPI Number: 1114973880
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1034337
LAB Type Pharmacy
Facility Name OSCO DRUG #2488
Street 655 MAIN ST N W
City BOURBONNAIS
State IL
ZIP 60914
Phone 815 929-0590
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/1/2024
Certificate Expiration Date 11/30/2026
Facility Type Pharmacy
Lab Director RACHEL RUSSELL

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