14D2220473 CLIA NUMBER - WALGREENS #05056

Laboratory Demographics

  • CLIA Code: 14D2220473
  • Facility Name: WALGREENS #05056
  • Facility Address: 4830 GRAND AVE
    GURNEE, IL
    ZIP 60031
  • Facility Phone: 847 662-2585
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANGELA CHA TIMONES
  • NPI Number: 1306852785
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2220473
LAB Type Pharmacy
Facility Name WALGREENS #05056
Street 4830 GRAND AVE
City GURNEE
State IL
ZIP 60031
Phone 847 662-2585
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/13/2025
Certificate Expiration Date 4/12/2027
Facility Type Pharmacy
Lab Director ANGELA CHA TIMONES

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