14D2175019 CLIA NUMBER - MARIANOS PHARMACY #531-540

Laboratory Demographics

CLIA Number: 14D2175019

Facility Name: MARIANOS PHARMACY #531-540

Facility Address:
144 GARY AVE
BLOOMINGDALE, IL
ZIP 60108
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Facility Phone Number: 630 671-9116

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1669915005

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	14D2175019
LAB Type	Pharmacy
Facility Name	MARIANOS PHARMACY #531-540
Street	144 GARY AVE
City	BLOOMINGDALE
State	IL
ZIP	60108
Phone	630 671-9116
CertificateType	4
CertificateEffectiveDate	11/14/2023
CertificateExpirationDate	11/13/2025
FacilityType	Waiver

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