14D2016543 CLIA NUMBER - OSCO DRUG # 3632

Laboratory Demographics

  • CLIA Code: 14D2016543
  • Facility Name: OSCO DRUG # 3632
  • Facility Address: 3630 N SOUTHPORT AVE
    CHICAGO, IL
    ZIP 60613
  • Facility Phone: (773) 327-1485
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RACHEL RUSSELL
  • NPI Number: 1184930984
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2016543
LAB Type Pharmacy
Facility Name OSCO DRUG # 3632
Street 3630 N SOUTHPORT AVE
City CHICAGO
State IL
ZIP 60613
Phone 7733271485
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/19/2024
Certificate Expiration Date 11/18/2026
Facility Type Pharmacy
Lab Director RACHEL RUSSELL

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This page was last updated on: 5/18/2026