14D2224658 CLIA NUMBER - WALGREENS #05104

Laboratory Demographics

  • CLIA Code: 14D2224658
  • Facility Name: WALGREENS #05104
  • Facility Address: 5525 159TH ST
    OAK FOREST, IL
    ZIP 60452
  • Facility Phone: 708 535-6018
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH C. SEBASTIAN
  • NPI Number: 1912284811
  • Taxonomy: 305S00000X - Point of Service

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CLIA Record

Field Name Field Value
CLIA Number 14D2224658
LAB Type Pharmacy
Facility Name WALGREENS #05104
Street 5525 159TH ST
City OAK FOREST
State IL
ZIP 60452
Phone 708 535-6018
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/14/2025
Certificate Expiration Date 5/13/2027
Facility Type Pharmacy
Lab Director KENNETH C. SEBASTIAN

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