14D2036083 CLIA NUMBER - MARIANO'S PHARMACY #8520

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Laboratory Demographics

CLIA Number: 14D2036083

Facility Name: MARIANO'S PHARMACY #8520

Facility Address:
3145 S ASHLAND AVE
CHICAGO, IL
ZIP 60608
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Facility Phone Number: 773 247-3394

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1376974170

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	14D2036083
LAB Type	Pharmacy
Facility Name	MARIANO'S PHARMACY #8520
Street	3145 S ASHLAND AVE
City	CHICAGO
State	IL
ZIP	60608
Phone	773 247-3394
CertificateType	4
CertificateEffectiveDate	1/31/2024
CertificateExpirationDate	1/30/2026
FacilityType	Waiver

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