14D2015203 CLIA NUMBER - WALGREENS #05103

Laboratory Demographics

  • CLIA Code: 14D2015203
  • Facility Name: WALGREENS #05103
  • Facility Address: 5932 W CERMAK RD
    CICERO, IL
    ZIP 60804
  • Facility Phone: 708 652-4856
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RONALD K. LEE
  • NPI Number: 1770590762
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2015203
LAB Type Pharmacy
Facility Name WALGREENS #05103
Street 5932 W CERMAK RD
City CICERO
State IL
ZIP 60804
Phone 708 652-4856
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2025
Certificate Expiration Date 8/31/2027
Facility Type Pharmacy
Lab Director RONALD K. LEE

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