14D2083420 CLIA NUMBER - WALGREENS 15667

Laboratory Demographics

  • CLIA Code: 14D2083420
  • Facility Name: WALGREENS 15667
  • Facility Address: 122 S MICHIGAN AVE
    CHICAGO, IL
    ZIP 60603
  • Facility Phone: 312 973-3708
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SHIRLEY S. TAM
  • NPI Number: 1770999005
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2083420
LAB Type Pharmacy
Facility Name WALGREENS 15667
Street 122 S MICHIGAN AVE
City CHICAGO
State IL
ZIP 60603
Phone 312 973-3708
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/6/2023
Certificate Expiration Date 10/5/2025
Facility Type Pharmacy
Lab Director SHIRLEY S. TAM

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