14D2015166 CLIA NUMBER - WALGREENS # 04461

Laboratory Demographics

  • CLIA Code: 14D2015166
  • Facility Name: WALGREENS # 04461
  • Facility Address: 501 W ROOSEVELT RD
    CHICAGO, IL
    ZIP 60607
  • Facility Phone: 312 492-8559
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ABDULKADER ALDAIF
  • NPI Number: 1962417139
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2015166
LAB Type Pharmacy
Facility Name WALGREENS # 04461
Street 501 W ROOSEVELT RD
City CHICAGO
State IL
ZIP 60607
Phone 312 492-8559
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/18/2025
Certificate Expiration Date 2/17/2027
Facility Type Pharmacy
Lab Director ABDULKADER ALDAIF

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