14D2058509 CLIA NUMBER - WALGREENS #15635

Laboratory Demographics

  • CLIA Code: 14D2058509
  • Facility Name: WALGREENS #15635
  • Facility Address: 3959 W 95TH ST
    EVERGREEN PARK, IL
    ZIP 60805
  • Facility Phone: 708 857-7922
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SHEA L. KOCH
  • NPI Number: 1154336303
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2058509
LAB Type Pharmacy
Facility Name WALGREENS #15635
Street 3959 W 95TH ST
City EVERGREEN PARK
State IL
ZIP 60805
Phone 708 857-7922
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/16/2025
Certificate Expiration Date 6/15/2027
Facility Type Pharmacy
Lab Director SHEA L. KOCH

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