14D2234378 CLIA NUMBER - WALGREENS #05825

Laboratory Demographics

  • CLIA Code: 14D2234378
  • Facility Name: WALGREENS #05825
  • Facility Address: 1213 W 79TH ST
    CHICAGO, IL
    ZIP 60620
  • Facility Phone: 773 651-2118
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LUCIUS JENKINS
  • NPI Number: 1699780817
  • Taxonomy: 333600000X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/31/2025
Certificate Expiration Date 8/30/2027
Facility Type Pharmacy
Lab Director LUCIUS JENKINS

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