14D2049931 CLIA NUMBER - WALGREENS #09505

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Laboratory Demographics

CLIA Number: 14D2049931

Facility Name: WALGREENS #09505

Facility Address:
445 E MAPLE AVE
ROSELLE, IL
ZIP 60172
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Facility Phone Number: 630 893-5171

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1457387714

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	14D2049931
LAB Type	Pharmacy
Facility Name	WALGREENS #09505
Street	445 E MAPLE AVE
City	ROSELLE
State	IL
ZIP	60172
Phone	630 893-5171
CertificateType	4
CertificateEffectiveDate	2/5/2023
CertificateExpirationDate	2/4/2025
FacilityType	Waiver

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