14D2080319 CLIA NUMBER - OSCO DRUG #2504

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Laboratory Demographics

CLIA Number: 14D2080319

Facility Name: OSCO DRUG #2504

Facility Address:
3243 W 115TH ST
MERRIONETTE PARK, IL
ZIP 60803
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Facility Phone Number: 708 389-9021

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1609293539

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	14D2080319
LAB Type	Pharmacy
Facility Name	OSCO DRUG #2504
Street	3243 W 115TH ST
City	MERRIONETTE PARK
State	IL
ZIP	60803
Phone	708 389-9021
CertificateType	4
CertificateEffectiveDate	7/3/2022
CertificateExpirationDate	7/2/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024