14D2049154 CLIA NUMBER - WALGREENS #10485

Laboratory Demographics

  • CLIA Code: 14D2049154
  • Facility Name: WALGREENS #10485
  • Facility Address: 12854 S ASHLAND AVE
    CALUMET PARK, IL
    ZIP 60827
  • Facility Phone: 708 239-1136
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SOLOMON A. TAM
  • NPI Number: 1194730408
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2049154
LAB Type Pharmacy
Facility Name WALGREENS #10485
Street 12854 S ASHLAND AVE
City CALUMET PARK
State IL
ZIP 60827
Phone 708 239-1136
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/12/2025
Certificate Expiration Date 5/11/2027
Facility Type Pharmacy
Lab Director SOLOMON A. TAM

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