14D2060965 CLIA NUMBER - WALGREENS 01503

Laboratory Demographics

  • CLIA Code: 14D2060965
  • Facility Name: WALGREENS 01503
  • Facility Address: 1926 WEST 35TH ST
    CHICAGO, IL
    ZIP 60609
  • Facility Phone: 773 254-5523
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MANUEL D. GOMEZ
  • NPI Number: 1245245463
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2060965
LAB Type Pharmacy
Facility Name WALGREENS 01503
Street 1926 WEST 35TH ST
City CHICAGO
State IL
ZIP 60609
Phone 773 254-5523
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/30/2024
Certificate Expiration Date 1/29/2026
Facility Type Pharmacy
Lab Director MANUEL D. GOMEZ

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