14D2224317 CLIA NUMBER - WALGREENS #04743

Laboratory Demographics

CLIA Number: 14D2224317

Facility Name: WALGREENS #04743

Facility Address:
16675 OAK PARK AVE
TINLEY PARK, IL
ZIP 60477
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Facility Phone Number: 708 429-0880

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1285641217

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	14D2224317
LAB Type	Pharmacy
Facility Name	WALGREENS #04743
Street	16675 OAK PARK AVE
City	TINLEY PARK
State	IL
ZIP	60477
Phone	708 429-0880
CertificateType	4
CertificateEffectiveDate	5/12/2023
CertificateExpirationDate	5/11/2025
FacilityType	Waiver

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