14D2058495 CLIA NUMBER - WALGREENS #13106

Laboratory Demographics

  • CLIA Code: 14D2058495
  • Facility Name: WALGREENS #13106
  • Facility Address: 11801 S AVENUE O
    CHICAGO, IL
    ZIP 60617
  • Facility Phone: 773 731-2147
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JACQUELINE BURKAT
  • NPI Number: 1801802277
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2058495
LAB Type Pharmacy
Facility Name WALGREENS #13106
Street 11801 S AVENUE O
City CHICAGO
State IL
ZIP 60617
Phone 773 731-2147
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/18/2025
Certificate Expiration Date 5/17/2027
Facility Type Pharmacy
Lab Director JACQUELINE BURKAT

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