14D2282676 CLIA NUMBER - CVS/PHARMACY #07166 HIGHLAND PARK CVS, LLC

Laboratory Demographics

  • CLIA Code: 14D2282676
  • Facility Name: CVS/PHARMACY #07166 HIGHLAND PARK CVS, LLC
  • Facility Address: 250 W 144TH ST
    RIVERDALE, IL
    ZIP 60827
  • Facility Phone: 708 849-5512
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MOTAZ NASSAN
  • NPI Number: 1184728032
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2282676
LAB Type Pharmacy
Facility Name CVS/PHARMACY #07166 HIGHLAND PARK CVS, LLC
Street 250 W 144TH ST
City RIVERDALE
State IL
ZIP 60827
Phone 708 849-5512
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 MOTAZ NASSAN

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