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14D2115367 CLIA NUMBER - MARIANO'S PHARMACY #8517

Laboratory Demographics

CLIA Number: 14D2115367

Facility Name: MARIANO'S PHARMACY #8517

Facility Address:
11000 S CICERO AVE
OAK LAWN, IL
ZIP 60453
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Facility Phone Number: 708 346-0726

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1194133280

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 14D2115367
LAB Type Pharmacy
Facility Name MARIANO'S PHARMACY #8517
Street 11000 S CICERO AVE
City OAK LAWN
State IL
ZIP 60453
Phone 708 346-0726
CertificateType 4
CertificateEffectiveDate 7/6/2022
CertificateExpirationDate 7/5/2024
FacilityType Waiver

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