14D2283706 CLIA NUMBER - CVS/PHARMACY #02845 HIGHLAND PARK CVS, LLC

Laboratory Demographics

  • CLIA Code: 14D2283706
  • Facility Name: CVS/PHARMACY #02845 HIGHLAND PARK CVS, LLC
  • Facility Address: 1930 W 103RD ST
    CHICAGO, IL
    ZIP 60643
  • Facility Phone: 773 239-8041
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JUDEH SHOROK
  • NPI Number: 1013011956
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2283706
LAB Type Physician Office
Facility Name CVS/PHARMACY #02845 HIGHLAND PARK CVS, LLC
Street 1930 W 103RD ST
City CHICAGO
State IL
ZIP 60643
Phone 773 239-8041
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/12/2025
Certificate Expiration Date 6/11/2027
Facility Type Physician Office
Lab Director JUDEH SHOROK

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