14D2251100 CLIA NUMBER - MILLENNIUM PHARMACY

Laboratory Demographics

  • CLIA Code: 14D2251100
  • Facility Name: MILLENNIUM PHARMACY
  • Facility Address: 10604 SOUTHWEST HWY - STE 102
    CHICAGO RIDGE, IL
    ZIP 60415
  • Facility Phone: 708 930-5393
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MAHMOUD MAHAFZAH
  • NPI Number: 1689163503
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2251100
LAB Type Pharmacy
Facility Name MILLENNIUM PHARMACY
Street 10604 SOUTHWEST HWY - STE 102
City CHICAGO RIDGE
State IL
ZIP 60415
Phone 708 930-5393
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/1/2024
Certificate Expiration Date 1/31/2026
Facility Type Pharmacy
Lab Director MAHMOUD MAHAFZAH

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