14D2234626 CLIA NUMBER - WALGREENS #05149

Laboratory Demographics

  • CLIA Code: 14D2234626
  • Facility Name: WALGREENS #05149
  • Facility Address: 1600 W ROOSEVELT RD
    BROADVIEW, IL
    ZIP 60155
  • Facility Phone: 708 343-5323
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JUSTIN A. ORNDER
  • NPI Number: 1891700936
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2234626
LAB Type Pharmacy
Facility Name WALGREENS #05149
Street 1600 W ROOSEVELT RD
City BROADVIEW
State IL
ZIP 60155
Phone 708 343-5323
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2025
Certificate Expiration Date 8/31/2027
Facility Type Pharmacy
Lab Director JUSTIN A. ORNDER

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