14D2015071 CLIA NUMBER - WALGREENS #03539

Laboratory Demographics

  • CLIA Code: 14D2015071
  • Facility Name: WALGREENS #03539
  • Facility Address: 11 E 75TH ST
    CHICAGO, IL
    ZIP 60619
  • Facility Phone: 773 224-1211
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRIANCCA C. MARSHALL
  • NPI Number: 1952318941
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2015071
LAB Type Pharmacy
Facility Name WALGREENS #03539
Street 11 E 75TH ST
City CHICAGO
State IL
ZIP 60619
Phone 773 224-1211
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/1/2023
Certificate Expiration Date 10/31/2025
Facility Type Pharmacy
Lab Director BRIANCCA C. MARSHALL

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