14D2282562 CLIA NUMBER - CVS/PHARMACY #02790 HIGHLAND PARK CVS LLC

Laboratory Demographics

  • CLIA Code: 14D2282562
  • Facility Name: CVS/PHARMACY #02790 HIGHLAND PARK CVS LLC
  • Facility Address: 3201 W 95TH ST
    CHICAGO, IL
    ZIP 60805
  • Facility Phone: 708 499-8811
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MATTHEW WERNER
  • NPI Number: 1487758322
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2282562
LAB Type Pharmacy
Facility Name CVS/PHARMACY #02790 HIGHLAND PARK CVS LLC
Street 3201 W 95TH ST
City CHICAGO
State IL
ZIP 60805
Phone 708 499-8811
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/23/2025
Certificate Expiration Date 5/22/2027
Facility Type Pharmacy
Lab Director MATTHEW WERNER

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This page was last updated on: 6/4/2025