14D2053834 CLIA NUMBER - WALGREENS 04752

Laboratory Demographics

  • CLIA Code: 14D2053834
  • Facility Name: WALGREENS 04752
  • Facility Address: 316 W CERMAK RD
    CHICAGO, IL
    ZIP 60616
  • Facility Phone: 312 791-0392
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: YOU FEN LEI
  • NPI Number: 1538174719
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2053834
LAB Type Pharmacy
Facility Name WALGREENS 04752
Street 316 W CERMAK RD
City CHICAGO
State IL
ZIP 60616
Phone 312 791-0392
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/6/2023
Certificate Expiration Date 12/5/2025
Facility Type Pharmacy
Lab Director YOU FEN LEI

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