14D2049163 CLIA NUMBER - WALGREENS #04874

Laboratory Demographics

  • CLIA Code: 14D2049163
  • Facility Name: WALGREENS #04874
  • Facility Address: 6600 WILLOW SPRINGS RD
    LA GRANGE HIGHLANDS, IL
    ZIP 60525
  • Facility Phone: 708 588-1253
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DIGVIJAY M. RAOL
  • NPI Number: 1750396057
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2049163
LAB Type Pharmacy
Facility Name WALGREENS #04874
Street 6600 WILLOW SPRINGS RD
City LA GRANGE HIGHLANDS
State IL
ZIP 60525
Phone 708 588-1253
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/18/2025
Certificate Expiration Date 2/17/2027
Facility Type Pharmacy
Lab Director DIGVIJAY M. RAOL

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This page was last updated on: 3/20/2025