14D2053832 CLIA NUMBER - WALGREENS #03074

Laboratory Demographics

  • CLIA Code: 14D2053832
  • Facility Name: WALGREENS #03074
  • Facility Address: 4700 S HALSTED ST
    CHICAGO, IL
    ZIP 60609
  • Facility Phone: 773 927-8777
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DANIELLE CAMEAU
  • NPI Number: 1992712988
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2053832
LAB Type Pharmacy
Facility Name WALGREENS #03074
Street 4700 S HALSTED ST
City CHICAGO
State IL
ZIP 60609
Phone 773 927-8777
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/15/2025
Certificate Expiration Date 4/14/2027
Facility Type Pharmacy
Lab Director DANIELLE CAMEAU

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