14D2036090 CLIA NUMBER - MARIANO'S PHARMACY#8526

Laboratory Demographics

  • CLIA Code: 14D2036090
  • Facility Name: MARIANO'S PHARMACY#8526
  • Facility Address: 950 BROOKFOREST AVE
    SHOREWOOD, IL
    ZIP 60431
  • Facility Phone: 815 577-2747
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RYAN TUTKO
  • NPI Number: 1023449824
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2036090
LAB Type Pharmacy
Facility Name MARIANO'S PHARMACY#8526
Street 950 BROOKFOREST AVE
City SHOREWOOD
State IL
ZIP 60431
Phone 815 577-2747
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/1/2024
Certificate Expiration Date 1/31/2026
Facility Type Pharmacy
Lab Director RYAN TUTKO

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