14D2220105 CLIA NUMBER - CVS/PHARMACY #16324 HIGHLAND PARK CVS, LLC

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Laboratory Demographics

CLIA Number: 14D2220105

Facility Name: CVS/PHARMACY #16324 HIGHLAND PARK CVS, LLC

Facility Address:
1071 W CARL SANDBURG DR
GALESBURG, IL
ZIP 61401
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Facility Phone Number: 401 770-6431

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1245252055

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	14D2220105
LAB Type	Pharmacy
Facility Name	CVS/PHARMACY #16324 HIGHLAND PARK CVS, LLC
Street	1071 W CARL SANDBURG DR
City	GALESBURG
State	IL
ZIP	61401
Phone	401 770-6431
CertificateType	4
CertificateEffectiveDate	4/9/2023
CertificateExpirationDate	4/8/2025
FacilityType	Waiver

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