14D2059903 CLIA NUMBER - WALGREENS #15197

Laboratory Demographics

  • CLIA Code: 14D2059903
  • Facility Name: WALGREENS #15197
  • Facility Address: 6121 N BROADWAY ST
    CHICAGO, IL
    ZIP 60660
  • Facility Phone: 773 764-8961
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TATIANA B. TAMAS
  • NPI Number: 1912912221
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D2059903
LAB Type Pharmacy
Facility Name WALGREENS #15197
Street 6121 N BROADWAY ST
City CHICAGO
State IL
ZIP 60660
Phone 773 764-8961
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/12/2025
Certificate Expiration Date 5/11/2027
Facility Type Pharmacy
Lab Director TATIANA B. TAMAS

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