14D2051411 CLIA NUMBER - WALGREENS #04778

Laboratory Demographics

  • CLIA Code: 14D2051411
  • Facility Name: WALGREENS #04778
  • Facility Address: 701 S MIDLOTHIAN RD
    MUNDELEIN, IL
    ZIP 60060
  • Facility Phone: 847 949-7198
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: VLADIMIR PETRESKI
  • NPI Number: 1629083944
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2051411
LAB Type Pharmacy
Facility Name WALGREENS #04778
Street 701 S MIDLOTHIAN RD
City MUNDELEIN
State IL
ZIP 60060
Phone 847 949-7198
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/2/2024
Certificate Expiration Date 10/1/2026
Facility Type Pharmacy
Lab Director VLADIMIR PETRESKI

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