14D2234378 CLIA NUMBER - WALGREENS #05825

Laboratory Demographics

CLIA Number: 14D2234378

Facility Name: WALGREENS #05825

Facility Address:
1213 W 79TH ST
CHICAGO, IL
ZIP 60620
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Facility Phone Number: 773 651-2118

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1699780817

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	14D2234378
LAB Type	Pharmacy
Facility Name	WALGREENS #05825
Street	1213 W 79TH ST
City	CHICAGO
State	IL
ZIP	60620
Phone	773 651-2118
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