14D2234370 CLIA NUMBER - WALGREENS #06377

Laboratory Demographics

CLIA Number: 14D2234370

Facility Name: WALGREENS #06377

Facility Address:
13023 S LA GRANGE RD
PALOS PARK, IL
ZIP 60464
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Facility Phone Number: 708 361-2291

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1902811102

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	14D2234370
LAB Type	Pharmacy
Facility Name	WALGREENS #06377
Street	13023 S LA GRANGE RD
City	PALOS PARK
State	IL
ZIP	60464
Phone	708 361-2291
CertificateType	4
CertificateEffectiveDate	8/31/2023
CertificateExpirationDate	8/30/2025
FacilityType	Waiver

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