14D2027139 CLIA NUMBER - WALGREENS #05123

Laboratory Demographics

  • CLIA Code: 14D2027139
  • Facility Name: WALGREENS #05123
  • Facility Address: 10300 S MICHIGAN AVE
    CHICAGO, IL
    ZIP 60628
  • Facility Phone: 773 468-0602
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CALVIN L. BRYANT
  • NPI Number: 1144598194
  • Taxonomy: 183500000X - Pharmacist

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CLIA Record

Field Name Field Value
CLIA Number 14D2027139
LAB Type Pharmacy
Facility Name WALGREENS #05123
Street 10300 S MICHIGAN AVE
City CHICAGO
State IL
ZIP 60628
Phone 773 468-0602
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/4/2023
Certificate Expiration Date 11/3/2025
Facility Type Pharmacy
Lab Director CALVIN L. BRYANT

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