14D2049139 CLIA NUMBER - WALGREENS #12304

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Laboratory Demographics

CLIA Number: 14D2049139

Facility Name: WALGREENS #12304

Facility Address:
2744 N CALIFORNIA AVE
CHICAGO, IL
ZIP 60647
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Facility Phone Number: 773 342-2818

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1750517298

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	14D2049139
LAB Type	Pharmacy
Facility Name	WALGREENS #12304
Street	2744 N CALIFORNIA AVE
City	CHICAGO
State	IL
ZIP	60647
Phone	773 342-2818
CertificateType	4
CertificateEffectiveDate	1/27/2023
CertificateExpirationDate	1/26/2025
FacilityType	Waiver

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