14D2175019 CLIA NUMBER - MARIANOS PHARMACY #531-540

Laboratory Demographics

  • CLIA Code: 14D2175019
  • Facility Name: MARIANOS PHARMACY #531-540
  • Facility Address: 144 GARY AVE
    BLOOMINGDALE, IL
    ZIP 60108
  • Facility Phone: 630 671-9116
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STACY DOYLE
  • NPI Number: 1669915005
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2175019
LAB Type Pharmacy
Facility Name MARIANOS PHARMACY #531-540
Street 144 GARY AVE
City BLOOMINGDALE
State IL
ZIP 60108
Phone 630 671-9116
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/14/2023
Certificate Expiration Date 11/13/2025
Facility Type Pharmacy
Lab Director STACY DOYLE

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This page was last updated on: 6/4/2025