14D2282887 CLIA NUMBER - CVS/PHARMACY #06897 HIGHLAND PARK CVS LLC

Laboratory Demographics

  • CLIA Code: 14D2282887
  • Facility Name: CVS/PHARMACY #06897 HIGHLAND PARK CVS LLC
  • Facility Address: 1212 13TH AVE
    MENDOTA, IL
    ZIP 61342
  • Facility Phone: 815 538-2095
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ABDUL ATIF
  • NPI Number: 1376646042
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2282887
LAB Type Pharmacy
Facility Name CVS/PHARMACY #06897 HIGHLAND PARK CVS LLC
Street 1212 13TH AVE
City MENDOTA
State IL
ZIP 61342
Phone 815 538-2095
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/26/2025
Certificate Expiration Date 5/25/2027
Facility Type Pharmacy
Lab Director ABDUL ATIF

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