14D2059070 CLIA NUMBER - WALGREENS #05356

Laboratory Demographics

  • CLIA Code: 14D2059070
  • Facility Name: WALGREENS #05356
  • Facility Address: 4710 S WESTERN AVE
    CHICAGO, IL
    ZIP 60609
  • Facility Phone: 773 579-0366
  • Facility Type: Other - COVID TESTING
  • Facility Type: Waiver
  • Lab Director: RONALD K. LEE
  • NPI Number: 1316954498
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2059070
LAB Type Other - COVID TESTING
Facility Name WALGREENS #05356
Street 4710 S WESTERN AVE
City CHICAGO
State IL
ZIP 60609
Phone 773 579-0366
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/27/2025
Certificate Expiration Date 1/26/2027
Facility Type Other - COVID TESTING
Lab Director RONALD K. LEE

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