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14D2015295 CLIA NUMBER - WALGREENS # 11760

Laboratory Demographics

CLIA Number: 14D2015295

Facility Name: WALGREENS # 11760

Facility Address:
811 MADISON ST
OAK PARK, IL
ZIP 60302
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Facility Phone Number: 708 383-9009

Facility Type: Other - COVID 19 TESTING SITE

Certificate Type: Waiver
NPI Number: 1619982840

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 14D2015295
LAB Type Other - COVID 19 TESTING SITE
Facility Name WALGREENS # 11760
Street 811 MADISON ST
City OAK PARK
State IL
ZIP 60302
Phone 708 383-9009
CertificateType 4
CertificateEffectiveDate 12/23/2022
CertificateExpirationDate 12/22/2024
FacilityType Waiver

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