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14D2139830 CLIA NUMBER - WALMART PHARMACY #110

Laboratory Demographics

CLIA Number: 14D2139830

Facility Name: WALMART PHARMACY #110

Facility Address:
7535 S ASHLAND AVE
CHICAGO, IL
ZIP 60620
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Facility Phone Number: 773 420-0290

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1477944668

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 14D2139830
LAB Type Pharmacy
Facility Name WALMART PHARMACY #110
Street 7535 S ASHLAND AVE
City CHICAGO
State IL
ZIP 60620
Phone 773 420-0290
CertificateType 4
CertificateEffectiveDate 11/9/2023
CertificateExpirationDate 11/8/2025
FacilityType Waiver

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