14D2049910 CLIA NUMBER - WALGREENS #05086

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Laboratory Demographics

CLIA Number: 14D2049910

Facility Name: WALGREENS #05086

Facility Address:
3120 CHICAGO RD
SOUTH CHICAGO HEIGHTS, IL
ZIP 60411
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Facility Phone Number: 708 755-7972

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1538175096

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	14D2049910
LAB Type	Pharmacy
Facility Name	WALGREENS #05086
Street	3120 CHICAGO RD
City	SOUTH CHICAGO HEIGHTS
State	IL
ZIP	60411
Phone	708 755-7972
CertificateType	4
CertificateEffectiveDate	5/11/2023
CertificateExpirationDate	5/10/2025
FacilityType	Waiver

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