14D2234631 CLIA NUMBER - WALGREENS #04612

Laboratory Demographics

  • CLIA Code: 14D2234631
  • Facility Name: WALGREENS #04612
  • Facility Address: 2040 GLEN ELLYN RD
    GLENDALE HTS, IL
    ZIP 60139
  • Facility Phone: 630 539-6597
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TAEK CHON YONG
  • NPI Number: 1871508044
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2234631
LAB Type Pharmacy
Facility Name WALGREENS #04612
Street 2040 GLEN ELLYN RD
City GLENDALE HTS
State IL
ZIP 60139
Phone 630 539-6597
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 TAEK CHON YONG

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