14D2049910 CLIA NUMBER - WALGREENS #05086

Laboratory Demographics

  • CLIA Code: 14D2049910
  • Facility Name: WALGREENS #05086
  • Facility Address: 3120 CHICAGO RD
    SOUTH CHICAGO HEIGHTS, IL
    ZIP 60411
  • Facility Phone: 708 755-7972
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: IAN GYAMFI SARPONG
  • NPI Number: 1538175096
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2049910
LAB Type Pharmacy
Facility Name WALGREENS #05086
Street 3120 CHICAGO RD
City SOUTH CHICAGO HEIGHTS
State IL
ZIP 60411
Phone 708 755-7972
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/11/2023
Certificate Expiration Date 5/10/2025
Facility Type Pharmacy
Lab Director IAN GYAMFI SARPONG

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