14D2036130 CLIA NUMBER - MARIANO'S PHARMACY #8527

Laboratory Demographics

  • CLIA Code: 14D2036130
  • Facility Name: MARIANO'S PHARMACY #8527
  • Facility Address: 2021 W CHICAGO AVE
    CHICAGO, IL
    ZIP 60622
  • Facility Phone: 773 799-9004
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: THAO STIFF
  • NPI Number: 1801227608
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2036130
LAB Type Pharmacy
Facility Name MARIANO'S PHARMACY #8527
Street 2021 W CHICAGO AVE
City CHICAGO
State IL
ZIP 60622
Phone 773 799-9004
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 THAO STIFF

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