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14D2027139 CLIA NUMBER - WALGREENS #05123

Laboratory Demographics

CLIA Number: 14D2027139

Facility Name: WALGREENS #05123

Facility Address:
10300 S MICHIGAN AVE
CHICAGO, IL
ZIP 60628
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Facility Phone Number: 773 468-0602

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1144598194

Taxonomy: 183500000X - Pharmacist
An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care.

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
CertificateType 4
CertificateEffectiveDate 11/4/2023
CertificateExpirationDate 11/3/2025
FacilityType Waiver

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