14D2015242 CLIA NUMBER - WALGREENS #05927

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Laboratory Demographics

CLIA Number: 14D2015242

Facility Name: WALGREENS #05927

Facility Address:
324 ROOSEVELT RD
GLEN ELLYN, IL
ZIP 60137
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Facility Phone Number: 630 858-2930

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1689681678

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	14D2015242
LAB Type	Pharmacy
Facility Name	WALGREENS #05927
Street	324 ROOSEVELT RD
City	GLEN ELLYN
State	IL
ZIP	60137
Phone	630 858-2930
CertificateType	4
CertificateEffectiveDate	2/20/2023
CertificateExpirationDate	2/19/2025
FacilityType	Waiver

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