14D2015159 CLIA NUMBER - WALGREENS #04306

Laboratory Demographics

  • CLIA Code: 14D2015159
  • Facility Name: WALGREENS #04306
  • Facility Address: 1633 W 95TH ST
    CHICAGO, IL
    ZIP 60643
  • Facility Phone: 773 445-9277
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LUCIUS JENKINS
  • NPI Number: 1447265665
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2015159
LAB Type Pharmacy
Facility Name WALGREENS #04306
Street 1633 W 95TH ST
City CHICAGO
State IL
ZIP 60643
Phone 773 445-9277
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/3/2023
Certificate Expiration Date 11/2/2025
Facility Type Pharmacy
Lab Director LUCIUS JENKINS

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