14D2282626 CLIA NUMBER - CVS/PHARMACY #04793 HIGHLAND PARK CVS, LLC

Laboratory Demographics

  • CLIA Code: 14D2282626
  • Facility Name: CVS/PHARMACY #04793 HIGHLAND PARK CVS, LLC
  • Facility Address: 1211 W ROOSEVELT BLVD
    CHICAGO, IL
    ZIP 60608
  • Facility Phone: 312 733-0147
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CANDACE TRAYLOR-HOLT
  • NPI Number: 1750606844
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2282626
LAB Type Pharmacy
Facility Name CVS/PHARMACY #04793 HIGHLAND PARK CVS, LLC
Street 1211 W ROOSEVELT BLVD
City CHICAGO
State IL
ZIP 60608
Phone 312 733-0147
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/24/2025
Certificate Expiration Date 5/23/2027
Facility Type Pharmacy
Lab Director CANDACE TRAYLOR-HOLT

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