14D2108696 CLIA NUMBER - MARIANO'S PHARMACY

Laboratory Demographics

CLIA Number: 14D2108696

Facility Name: MARIANO'S PHARMACY

Facility Address:
9504 WEST 142ND ST
ORLAND PARK, IL
ZIP 60462
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Facility Phone Number: 708 226-0027

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1548625551

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	14D2108696
LAB Type	Pharmacy
Facility Name	MARIANO'S PHARMACY
Street	9504 WEST 142ND ST
City	ORLAND PARK
State	IL
ZIP	60462
Phone	708 226-0027
CertificateType	4
CertificateEffectiveDate	2/9/2024
CertificateExpirationDate	2/8/2026
FacilityType	Waiver

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