14D2056279 CLIA NUMBER - WALGREENS #00089

Laboratory Demographics

  • CLIA Code: 14D2056279
  • Facility Name: WALGREENS #00089
  • Facility Address: 8715 S HARLEM AVE
    BRIDGEVIEW, IL
    ZIP 60455
  • Facility Phone: 708 598-2511
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MAICE KUTOM
  • NPI Number: 1275540262
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D2056279
LAB Type Pharmacy
Facility Name WALGREENS #00089
Street 8715 S HARLEM AVE
City BRIDGEVIEW
State IL
ZIP 60455
Phone 708 598-2511
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/18/2025
Certificate Expiration Date 8/17/2027
Facility Type Pharmacy
Lab Director MAICE KUTOM

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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