14D2015189 CLIA NUMBER - WALGREENS #04940

Laboratory Demographics

  • CLIA Code: 14D2015189
  • Facility Name: WALGREENS #04940
  • Facility Address: 305 W ROLLINS RD
    ROUND LAKE BEACH, IL
    ZIP 60073
  • Facility Phone: (847) 546-7193
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NICHOLAS M. SIMON
  • NPI Number: 1356356497
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2015189
LAB Type Pharmacy
Facility Name WALGREENS #04940
Street 305 W ROLLINS RD
City ROUND LAKE BEACH
State IL
ZIP 60073
Phone 8475467193
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/14/2025
Certificate Expiration Date 5/13/2027
Facility Type Pharmacy
Lab Director NICHOLAS M. SIMON

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This page was last updated on: 5/18/2026