14D2226832 CLIA NUMBER - CVS/PHARMACY #17166 HIGHLAND PARK CVS LLC

Laboratory Demographics

CLIA Number: 14D2226832

Facility Name: CVS/PHARMACY #17166 HIGHLAND PARK CVS LLC

Facility Address:
1940 W 33RD ST
CHICAGO, IL
ZIP 60608
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Facility Phone Number: 866 389-2727

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1760404479

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	14D2226832
LAB Type	Pharmacy
Facility Name	CVS/PHARMACY #17166 HIGHLAND PARK CVS LLC
Street	1940 W 33RD ST
City	CHICAGO
State	IL
ZIP	60608
Phone	866 389-2727
CertificateType	4
CertificateEffectiveDate	6/4/2023
CertificateExpirationDate	6/3/2025
FacilityType	Waiver

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