14D2015293 CLIA NUMBER - WALGREENS #11109

Laboratory Demographics

  • CLIA Code: 14D2015293
  • Facility Name: WALGREENS #11109
  • Facility Address: 4800 148TH SREET
    MIDLOTHIAN, IL
    ZIP 60445
  • Facility Phone: 708 687-1604
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GREGORY M. MAVROVIC
  • NPI Number: 1710992938
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2015293
LAB Type Pharmacy
Facility Name WALGREENS #11109
Street 4800 148TH SREET
City MIDLOTHIAN
State IL
ZIP 60445
Phone 708 687-1604
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/18/2025
Certificate Expiration Date 2/17/2027
Facility Type Pharmacy
Lab Director GREGORY M. MAVROVIC

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