14D2071388 CLIA NUMBER - WALGREENS #11410

Laboratory Demographics

  • CLIA Code: 14D2071388
  • Facility Name: WALGREENS #11410
  • Facility Address: 1627 N PULASKI RD
    CHICAGO, IL
    ZIP 60639
  • Facility Phone: 773 772-5432
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CARLA J. RACANELLI
  • NPI Number: 1134136120
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2071388
LAB Type Pharmacy
Facility Name WALGREENS #11410
Street 1627 N PULASKI RD
City CHICAGO
State IL
ZIP 60639
Phone 773 772-5432
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/5/2025
Certificate Expiration Date 5/4/2027
Facility Type Pharmacy
Lab Director CARLA J. RACANELLI

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