14D2031640 CLIA NUMBER - WALGREENS 13798

Laboratory Demographics

  • CLIA Code: 14D2031640
  • Facility Name: WALGREENS 13798
  • Facility Address: 5440 N CLARK
    CHICAGO, IL
    ZIP 60640
  • Facility Phone: 773 596-5022
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ABDALLAH M. DMOUR
  • NPI Number: 1891081592
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2031640
LAB Type Physician Office
Facility Name WALGREENS 13798
Street 5440 N CLARK
City CHICAGO
State IL
ZIP 60640
Phone 773 596-5022
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/23/2025
Certificate Expiration Date 8/22/2027
Facility Type Physician Office
Lab Director ABDALLAH M. DMOUR

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