14D2283707 CLIA NUMBER - CVS/PHARMACY #03170 HIGHLAND PARK CVS LLC

Laboratory Demographics

CLIA Number: 14D2283707

Facility Name: CVS/PHARMACY #03170 HIGHLAND PARK CVS LLC

Facility Address:
6417 W HIGGINS AVE
CHICAGO, IL
ZIP 60656
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Facility Phone Number: 773 631-5906

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1912001850

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	14D2283707
LAB Type	Pharmacy
Facility Name	CVS/PHARMACY #03170 HIGHLAND PARK CVS LLC
Street	6417 W HIGGINS AVE
City	CHICAGO
State	IL
ZIP	60656
Phone	773 631-5906
CertificateType	4
CertificateEffectiveDate	6/12/2023
CertificateExpirationDate	6/11/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024