14D2283715 CLIA NUMBER - CVS/PHARMACY 07760 HIGHLAND PARK CVS LLC

Laboratory Demographics

  • CLIA Code: 14D2283715
  • Facility Name: CVS/PHARMACY 07760 HIGHLAND PARK CVS LLC
  • Facility Address: 199000 S LA GRANGE RD
    MOKENA, IL
    ZIP 60448
  • Facility Phone: 708 478-1821
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LOAI HISHMEN
  • NPI Number: 1407083009
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2283715
LAB Type Pharmacy
Facility Name CVS/PHARMACY 07760 HIGHLAND PARK CVS LLC
Street 199000 S LA GRANGE RD
City MOKENA
State IL
ZIP 60448
Phone 708 478-1821
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 Pharmacy
Lab Director LOAI HISHMEN

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