14D2015205 CLIA NUMBER - WALGREENS # 05107

Laboratory Demographics

  • CLIA Code: 14D2015205
  • Facility Name: WALGREENS # 05107
  • Facility Address: 1701 E KENSINGTON RD
    MOUNT PROSPECT, IL
    ZIP 60056
  • Facility Phone: 847 635-9962
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: THOMAS P. BOCHULA
  • NPI Number: 1184639361
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2015205
LAB Type Pharmacy
Facility Name WALGREENS # 05107
Street 1701 E KENSINGTON RD
City MOUNT PROSPECT
State IL
ZIP 60056
Phone 847 635-9962
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/11/2025
Certificate Expiration Date 5/10/2027
Facility Type Pharmacy
Lab Director THOMAS P. BOCHULA

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