14D2021285 CLIA NUMBER - WALGREENS #05867

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Laboratory Demographics

CLIA Number: 14D2021285

Facility Name: WALGREENS #05867

Facility Address:
3943 W 47TH ST
CHICAGO, IL
ZIP 60632
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Facility Phone Number: 773 927-0523

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1144502212

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	14D2021285
LAB Type	Pharmacy
Facility Name	WALGREENS #05867
Street	3943 W 47TH ST
City	CHICAGO
State	IL
ZIP	60632
Phone	773 927-0523
CertificateType	4
CertificateEffectiveDate	8/31/2023
CertificateExpirationDate	8/30/2025
FacilityType	Waiver

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