14D2216776 CLIA NUMBER - WALGREENS #03179

Laboratory Demographics

  • CLIA Code: 14D2216776
  • Facility Name: WALGREENS #03179
  • Facility Address: 820 183RD ST
    HOMEWOOD, IL
    ZIP 60430
  • Facility Phone: (708) 957-9402
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ROBERT C. WILSAK
  • NPI Number: 1124033428
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2216776
LAB Type Pharmacy
Facility Name WALGREENS #03179
Street 820 183RD ST
City HOMEWOOD
State IL
ZIP 60430
Phone 7089579402
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/16/2025
Certificate Expiration Date 3/15/2027
Facility Type Pharmacy
Lab Director ROBERT C. WILSAK

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This page was last updated on: 5/18/2026