14D2015047 CLIA NUMBER - WALGREENS # 03072

Laboratory Demographics

  • CLIA Code: 14D2015047
  • Facility Name: WALGREENS # 03072
  • Facility Address: 641 N CLARK ST
    CHICAGO, IL
    ZIP 60654
  • Facility Phone: 312 587-1416
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CAN X. LAO
  • NPI Number: 1063427219
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2015047
LAB Type Pharmacy
Facility Name WALGREENS # 03072
Street 641 N CLARK ST
City CHICAGO
State IL
ZIP 60654
Phone 312 587-1416
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/10/2024
Certificate Expiration Date 9/9/2026
Facility Type Pharmacy
Lab Director CAN X. LAO

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