14D2218637 CLIA NUMBER - WALGREENS #04936

Laboratory Demographics

  • CLIA Code: 14D2218637
  • Facility Name: WALGREENS #04936
  • Facility Address: 4040 N CICERO AVE
    CHICAGO, IL
    ZIP 60641
  • Facility Phone: 773 283-5321
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AICHA BOUABDALAOUI
  • NPI Number: 1649285941
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2218637
LAB Type Pharmacy
Facility Name WALGREENS #04936
Street 4040 N CICERO AVE
City CHICAGO
State IL
ZIP 60641
Phone 773 283-5321
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/30/2025
Certificate Expiration Date 3/29/2027
Facility Type Pharmacy
Lab Director AICHA BOUABDALAOUI

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This page was last updated on: 9/29/2025