14D2015188 CLIA NUMBER - WALGREENS #04938

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Laboratory Demographics

CLIA Number: 14D2015188

Facility Name: WALGREENS #04938

Facility Address:
4748 W NORTH AVE
CHICAGO, IL
ZIP 60639
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Facility Phone Number: 773 745-6642

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1871500959

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	14D2015188
LAB Type	Pharmacy
Facility Name	WALGREENS #04938
Street	4748 W NORTH AVE
City	CHICAGO
State	IL
ZIP	60639
Phone	773 745-6642
CertificateType	4
CertificateEffectiveDate	5/4/2023
CertificateExpirationDate	5/3/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024