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14D2218212 CLIA NUMBER - CVS/PHARMACY #18077 HIGHLAND PARK CVS, LLC

Laboratory Demographics

CLIA Number: 14D2218212

Facility Name: CVS/PHARMACY #18077 HIGHLAND PARK CVS, LLC

Facility Address:
1701 E EMPIRE ST
BLOOMINGTON, IL
ZIP 61704
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Facility Phone Number: 401 770-6431

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1316178064

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name Field Value
CLIA Number 14D2218212
LAB Type Pharmacy
Facility Name CVS/PHARMACY #18077 HIGHLAND PARK CVS, LLC
Street 1701 E EMPIRE ST
City BLOOMINGTON
State IL
ZIP 61704
Phone 401 770-6431
CertificateType 4
CertificateEffectiveDate 3/26/2023
CertificateExpirationDate 3/25/2025
FacilityType Waiver

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